District Hospital Report For Digital Publication

BEST PRACTICES IN THE PERFORMANCE OF
Copyright@ NITI Aayog, 2021
NITI Aayog
Government of India,
Sansad Marg, New Delhi–110001, India
Report and Cover Design by YAAP
Suggested Citation
Rakesh Sarwal, Shoyabahmed Kalal, Vaishnavi Iyer (2021).
Best Practices in the Performance of District Hospitals. NITI Aayog.
ISBN: 978-81-953811-0-4
DOI: 10.17605/OSF.IO/JVQKF
Available at: https://www.niti.gov.in/verticals/health-and-family-

welfare
Disclaimer
Every care has been taken to provide accurate information along
with references thereof. Only validated data submitted by competent
authorities at the district and state levels have been used in the
assessment. However, NITI Aayog shall not be liable for any loss or
damage whatsoever, including incidental or consequential loss or
damage, arising out of, or in connection with any use of or reliance
on the information in this document.
Message from the Chief Executive Officer
Message from the

Chief Executive
Officer
A healthy population is a productive one, a happier one. The Government of India is committed
to this vision, as reflected in the National Health Policy 2017 and several other pathbreaking
initiatives such as the Ayushman Bharat Yojana.
This report is the first-ever performance assessment of district hospitals undertaken across the
country. It marks a major shift in the health care delivery system towards data-driven governance
and takes us even closer to communities and people availing health services. The entire objective
of the exercise is to pave the way for a more informed understanding of health care services
available in different regions and flag gaps, if any.
The Government has made significant progress in improving the health care system in India. It
has initiated major reforms to improve citizens’ access to quality and affordable health care at
a much greater pace. This assessment exercise also is a step in that direction.
Understanding the performance of district hospitals vis-à-vis a uniform set of indicators will
be useful for both the district and state officials involved in decision making and improving
service delivery.
I hope that the observations and recommendations presented in this report will help in guiding
the decision-makers at the state- and district-levels in taking informed and evidence-based
decisions and accelerate the transformation of the public health system in India.
Amitabh Kant
Chief Executive Officer
NITI Aayog
Government of India
New Delhi, India
Best Practices in the Performance of iii

District Hospitals in India
Foreword
Foreword
The progress in the health sector in India in terms of improved service delivery and outcome
in the last decade has been commendable. District hospitals have a pivotal role in creating
healthier communities, providing a wide spectrum of health care services that caters to all
individuals of the population. Despite their crucial role in providing advanced secondary care,
there are unfortunately gaps, be it shortage of human resources, capacities, utilization and service
uptake, quality issues, operational challenges, or sometimes just a lack of motivation amongst
hospital staff. To make “health for all” a reality and to ensure that every citizen has access to
safe and reliable health services, these gaps must be closed. The district hospital performance
assessment exercise undertaken by NITI Aayog is an important step in that direction.
NITI Aayog, in collaboration with the Ministry of Health and Family Welfare, World Health
Organization, and key stakeholders, has developed the first-ever comprehensive assessment
of the performance of district hospitals in India. The exercise captures the infrastructure and
service outputs of district hospitals, giving us useful data to understand their performance and
help pave the way towards better health outcomes.
Based on the monitoring framework developed in 2017, the validation exercise was initiated in
December 2018 and concluded in 2019 across 731 district hospitals in the country. This exercise
has now culminated in what is a large-scale baseline assessment of district hospitals across
the country covering 707 (97%) district hospitals. The Health Management Information System
(HMIS) data for the year 2017-18 has been used as baseline for this exercise.
This country-wide assessment of district hospitals on a pre-determined set of key performance
indicators will serve as a valuable resource that can help hospitals perform better as they
learn from one another. It will also encourage a sense of healthy competition and provide an
opportunity to showcase progress. In addition, it would bring about greater accountability for
quality health care facilities in district hospitals.
It is worth noting that this was the first time any large scale national onsite survey of hospital data
was done at the facility level. The exercise apart from making the abovementioned framework
of NITI Aayog more meaningful would also reveal comprehensive insights on HMIS and the
overall status of record maintenance and data reporting at the district hospital level. It will
Best Practices in the Performance of v

Foreword
create awareness among district hospitals regarding the HMIS and the importance of proper
record keeping.
The uniqueness of this report lies in how it has collected and used data around key parameters
of infrastructure and services that are available in the district hospitals. The findings from this
study may be used to deliver better health services. By celebrating data and assigning it priority,
the exercise has helped increase reliance on information technology for greater digitization and
optimization of data management. Finally, the initiative provides us with an essential tool to
track progress on crucial health care indicators on a regular basis.
We hope that this performance assessment will spur a movement that can demand better
health service delivery and strengthen the country’s health systems, minimizing disparities
and irregularities that exist in the quality of services offered across the board. Inevitably, this
would create a learning environment where hospitals can draw lessons from one another, share
best practices, and work collaboratively. A roadmap of action would likely emerge for district
hospitals in their quest for upgrading and improving service delivery. The goal of any national
health programme is to constantly strive for improved health outcomes for the populations
they serve. We hope this effort by NITI Aayog and the Ministry of Health and Family Welfare
is a step in that direction.
Dr Vinod K Paul
Member, NITI Aayog
vi Best Practices in the Performance of

Acknowledgments
Acknowledgments
This report on the best practices in the performance of district hospitals in India has been the
result of extensive consultations and collaboration with numerous stakeholders. NITI Aayog
would like to thank the Union Ministry of Health and Family Welfare and all officers in the
Department of Health and Family Welfare who supported and contributed significantly to
making this performance assessment exercise robust and well represented.
NITI Aayog is extremely grateful to the State Governments and Union Territories for their support
and assistance throughout the process of this exercise, right from finalizing the indicators up to
collating best practices of well performing district hospitals in the area of their excellence. We
also thank all district-level health officials for extending their support, coordinating with us, and
providing us with helpful information without which the project could not have been completed.
The selection of indicators and the report preparation have benefitted from technical support
provided by the World Health Organization India Country Office. I appreciate the contribution of
Dr Roderico Ofrin, WHO Representative to India; Ms Payden, Deputy WHO Representative
to India; Dr Hilde De Graeve, Team Lead, Health Systems; Dr Ved Prakash Yadav, National
Professional Officer, Health Information System; and Dr Sonali Rawal, National Professional
Officer, Patient Safety and Quality of Care.
I appreciate the support of the NABH team led by Mr. Adil Zainulbhai, Chairman, QCI; Dr Ravi
P. Singh, Secretary General, QCI; Dr Atul Mohan Kochhar, CEO, NABH; Dr Harish Nadkarni,
ex-CEO, NABH; Dr Kashipa Harit, Deputy Director and Project Head, NABH; and
Mr Arsh Hashmi, Project Associate, QCI.
The project was designed and conceptualised under the guidance of Dr Rajiv Kumar,
Vice Chairperson, NITI Aayog; Dr Vinod K Paul, Member, NITI Aayog; Mr Amitabh Kant, CEO,
NITI Aayog, and Mr Alok Kumar, former Adviser, Health and Family Welfare, NITI Aayog. The
Best Practices in the Performance of vii

Acknowledgments
report writing was done by a team of Shri Shoyabahmed Kalal, Deputy Secretary, NITI Aayog;
Vaishnavi Iyer, Young Professional, NITI Aayog; supported by Dr Bhanu Duggal, Professor &
HOD, Department of Cardiology, AIIMS, Rishikesh; Dr Kashipa Harit, NABH; Arsh Hashmi, QCI;
and Jyoti Khatter, Senior Research Officer, NITI Aayog. The NITI team also included budding
professionals namely Shreya Chaturvedi, Gaurika Saxena, Ashima Singh, and Shreya Jain, Interns,
who assisted in the compilation of the report.
Dr Rakesh Sarwal
Additional Secretary
NITI Aayog
Government of India
New Delhi, India
viii Best Practices in the Performance of

Table of Contents
Table of Contents
Message from the Chief Executive Officer iii

Foreword v
Acknowledgments vii
List of Abbreviations xiii
Executive Summary xvii
1. Introduction to District Hospitals: The Centrepiece of the Health Care Delivery

System..............................................................................................................................................1
1.1 Public health care in India 2
1.2 Towards improved health outcomes — SDGs and Ayushman Bharat 3
1.3 Role and importance of district hospitals 4
1.4 Role of a robust Health Management Information System (HMIS) 6
1.5 Global practices in hospital performance assessments 7
2. Rationale and Approach for the Performance Assessment of District Hospitals............9

2.1 Project background 10
2.2 Objectives of the project 10
2.3 Measures used in the assessment 11
2.4 Categorization of hospitals for analysis 11
2.5 Process for conducting assessment 12
2.6 Key results of data validation 13
2.7 Computation of KPI scores 14
3. Assessing District Hospitals with respect to the Key Performance Indicators (KPIs)........ 17
3.1 Number of functional beds per 100,000 population 20
3.2 Ratio of doctors, staff nurses, and paramedical staff in proportion to IPHS norms 25
Best Practices in the Performance of ix

Table of Contents
3.3 Availability of support services 34

3.4 Availability of core health care services 38
3.5 Availability of diagnostic testing services 42
3.6 Bed occupancy rate 47
3.7 C-section rate 53
3.8 Surgical productivity index 58
3.9 OPD per doctor 63
3.10 Blood bank replacement rate 68
4. Challenges and Limitations.......................................................................................................72

4.1 Issues and challenges during the data collection and validation exercise 73
4.2 Concerns with regard to KPIs and their associated HMIS data components 73
4.3 Limitations of the scoring process 74
5. Learnings and Way Forward.....................................................................................................75

5.1 Key learnings and observations from the district hospital performance assessment 76
5.2 Action points for stakeholders concerned 76
Annexures............................................................................................................................................. 81
Annexure 1: Health Management Information System 82
Annexure 2: Summary of Health Systems Studied 83
Annexure 3: Definitions of Key Performance Indicators (KPIs) for the District Hospital
Performance Assessment 88
Annexure 4: State/UT-wise top scoring district hospital for each Key Performance
Indicator (KPI) 95
Annexure 5: Graphs illustrating the State/UT-wise average raw score of each KPI for
each hospital category (small, mid-sized, and large) 103
Annexure 6: List of district hospitals having all requisite services (support services, core
health care services, diagnostic testing services) 117
Table 6A: List of district hospitals having all identified support services (N=14) 117
Table 6B: List of district hospitals having all identified core health care
services (N=14) 120
Table 6C: List of district hospitals having all identified diagnostic
testing services (N=14) 123
Annexure 7: KPI-wise raw scores for district hospitals 125
Table 7A - KPIs 1-5 126
Table 7B - KPIs 6-10 160
Table 7C - District and District Hospital Codes 191
x Best Practices in the Performance of

Table of Contents
LIST OF TABLES
Table 1: Distribution of hospital services accessed in India 3
Table 2: List of Key Performance Indicators (KPIs) to assess district hospitals 11
Table 3: Categorization of district hospitals 12
Table 4: Top performing district hospitals in the country for the KPI “Number of
functional beds per 100,000 population” 22
Table 5: Total medical and paramedical manpower requirements as per IPHS 25
Table 6: Count and percentage of district hospitals in each State/UT meeting IPHS
norms for medical and paramedical staff 26
Table 7: Top performing district hospitals in the country for the KPI “Ratio of doctors,
nurses and paramedical staff in position to IPHS norms” 29
Table 8: Top performing district hospitals in the country that have all the identified
support services (N=14) 36
Table 9: Top performing district hospitals in the country that have all the identified
core health care services (N=14) 40
Table 10: Top performing district hospitals in the country that have all or most of the
identified diagnostic testing services (N=14) 44
Table 11: Top performing district hospitals in the country that have a bed occupancy
rate up to 100% 50
Table 12: District hospitals in India with the highest C-section rate 55
Table 13: Top performing district hospitals in the country for the KPI “surgical
productivity index” 60
Table 14: Top performing district hospitals in the country for the KPI “OPD per doctor” 65
Table 15: Top performing district hospitals in the country that have a blood bank
replacement rate of 0% 69
LIST OF FIGURES
Figure 1: India’s three-tiered public health system 2
Figure 2a: State/UT-wise percentage of match between NABH onsite validated data and
corresponding HMIS values 14
Figure 2b: Indicator-wise percentage of match between NABH onsite validated data and
corresponding HMIS values 15
Figure 3a: Distribution of hospitals by size 18
Figure 3b: Distribution of district hospitals by state/UT 19
Figure 3.1.1: State/UT-wise average number of beds in a district hospital for every
1 lakh population 21
Figure 3.1.2: Percentage of district hospitals in each State/UT that have at least 22 beds
per 1 lakh population 22
Best Practices in the Performance of xi

Table of Contents
Figure 3.2.1: Percentage of district hospitals in each State/UT that meet the doctors to
bed ratio as per IPHS norm 28
Figure 3.2.2: State/UT-wise average ratio of doctors across hospitals in position to the
IPHS norms 30
Figure 3.2.3: State/UT-wise average ratio of nurses across hospitals in position to the
IPHS norms 31
Figure 3.2.4: State/UT-wise average ratio of paramedical staff across hospitals in position
to the IPHS norms 31
Figure 3.3.1: State/UT-wise distribution of the number of hospitals (n=89) with availability
of all support services 35
Figure 3.3.2: Average number of support services in a district hospital by State/UT 36
Figure 3.4.1: State/UT-wise distribution of number of hospitals (n=101) with all 14 functional
core health care services 39
Figure 3.4.2: State/UT-wise average number of available core health care services in a
district hospital 40
Figure 3.5.1: State/UT-wise distribution of number of district hospitals (n=21) with all
14 functional diagnostic testing services available 43
Figure 3.5.2: State/UT-wise average number of available diagnostic testing services in a
district hospital 44
Figure 3.6.1: Average bed occupancy rate (%) of a district hospital by State/UT 48
Figure 3.6.2: State/UT-wise number of district hospitals (n=182) with bed occupancy rate
of 90% or higher 49
Figure 3.6.3: Percentage of district hospitals in each State/UT that have a bed occupancy
rate of at least 80 per cent 49
Figure 3.7.1: Average percentage of C-section deliveries in a district hospital by State/UT 54
Figure 3.7.2: Number of district hospitals by State/UT having C-section rate less than 35% 54
Figure 3.8.1: State/UT-wise distribution of number of district hospitals (n=177) in the upper
quartile for surgical productivity index 59
Figure 3.8.2: Average number of surgeries per surgeon performed in a year in a district
hospital by State/UT 59
Figure 3.9.1: State/UT-wise distribution of number of district hospitals (n=177) having doctors
attending to 34 or more OPD patients per day 64
Figure 3.9.2: Average number of OPD patients per doctor in a day in a district hospital by
State/UT 64
Figure 3.10: Average number of blood units issued on replacement in a year in a district
hospital by State/UT 69
xii Best Practices in the Performance of

List of Abbreviations
ABARK Ayushman Bharat – Arogya Karnataka

ANM Auxiliary Nurse Midwife
AYUSH Ayurveda, Yoga & Naturopathy, Unani, Siddha And Homeopathy
BDS Bachelor Of Dental Surgery
BY Base Year
CBC Complete Blood Count
CCU Cardiac Care Unit
CEO Chief Executive Officer
CHC Community Health Centre
CMO Chief Medical Officer
CRS Civil Registration System
CRVS Civil Registration And Vital Statistics
C-section Caesarean Section
CSSD Central Sterile Supply Department
DH District Hospital
DPT Diphtheria, Pertussis And Tetanus
DVDMS Drugs And Vaccines Distribution Management System
EAG Empowered Action Group
ENT Ear-Nose-Throat
FLV First-Level Verification
FRU First Referral Unit
HDU High Dependency Unit
HIS Hospital Information System
Best Practices in the Performance of xiii

HIV Human Immunodeficiency Virus

HMIS Health Management Information System
HRMIS Human Resources Management Information System
HWC Health And Wellness Centre
ICU Intensive Care Unit
IDSP Integrated Disease Surveillance Programme
IEC Information, Education And Communication
IMR Infant Mortality Rate
INR Indian Rupees
IPD Inpatient Department
IPHS Indian Public Health System
ISO International Organization For Standardization
IT Information Technology
IVA Independent Validation Agency
KFT Kidney Function Test
KPI Key Performance Indicator
LBW Low Birth Weight
LFT Liver Function Test
LDR Labour And Delivery Room
MBBS Bachelor Of Medicine And A Bachelor Of Surgery
MCH Maternal And Child Health
MCI Medical Council Of India
MIS Management Information System
MMR Maternal Mortality Ratio
MO Medical Officer
MoH&FW Ministry Of Health And Family Welfare
NA Not Applicable
NABH National Accreditation Board For Hospitals And Healthcare Providers
NACO National Aids Control Organization
NCD Non-Communicable Disease
NE North-Eastern
NFHS National Family Health Survey
NHM National Health Mission
NHP National Health Policy
NHSRC National Health Systems Resource Centre
NITI Aayog National Institution For Transforming India
xiv Best Practices in the Performance of

NMR Neonatal Mortality Rate

NQAS National Quality Assurance Standards
OPV Oral Polio Vaccine
OPD Outpatient Department
ORGI Office Of The Registrar General And Census Commissioner Of India
OT Operation Theatre
PAP Papanicolaou
P FORM IDSP Reporting Format For Presumptive Surveillance
PHC Primary Health Centre
PLHIV People Living With Hiv
PIPs Programme Implementation Plans
PGI Post-Graduate Institute
RRC-NE Regional Resource Centre For North-Eastern States
RNTCP Revised National Tuberculosis Control Programme
RU Reporting Unit
SC Sub-Centre
SDG Sustainable Development Goals
SDH Sub-District Hospital
SRB Sex Ratio At Birth
SRS Sample Registration System
SN Staff Nurse
SNO State Nodal Officer
SNCU Special Newborn Care Unit
TA Technical Assistance
TB Tuberculosis
TFR Total Fertility Rate
U5MR Under-Five Mortality Rate
UT Union Territory
UHC Universal Health Coverage
Best Practices in the Performance of xv

Executive Summary
Executive Summary
India has made significant progress in improving its health outcomes over the last two decades.
Many key indicators, however, continue to show considerable scope for improvement. Considering
the needs of health care in the country, the Government of India has made ambitious global
and national commitments to further improve health outcomes. To honour these commitments,
it is important to measure and evaluate the performance of the public health infrastructure.
District hospitals are a valuable resource providing secondary level of health care, which includes
comprehensive preventive, promotive and curative services. Currently, there are more than 800
district hospitals across the country providing crucial services to the population. In view of a
large fund allocation for district hospitals under the National Health Mission (NHM), as well as
their critical role in health care provision, there is a need to set up a comprehensive system
to assess their performance holistically. Therefore, NITI Aayog took up to create a framework
for tracking the performance of these government hospitals, based on key parameters that
illuminate the health of our hospitals.
NITI Aayog conducted a detailed study on the domestic and international health systems, in
consultations with the World Health Organization, Ministry of Health and Family Welfare, and
other stakeholders, in order to determine the domains and specific indicators that are required
to be included in this holistic assessment of hospitals. This is the first-ever pan-India assessment
at the district level that draws upon physical validation of the data from the Health Management
Information System (HMIS) to benchmark the district hospitals on a diverse mix of input and
output indicators. The assessment looked at a wide array of health indicators ranging from
beds, doctors, nurses, paramedics, diagnostic and health care facilities to the rate of Caesarean
section surgeries and bed occupancy, amongst others. Of the ten Key Performance Indicators
(KPIs) used in this exercise, five portray the level of infrastructure these district level hospitals
have, and the remaining indicate the output these hospitals are generating.
A total of 707 district hospitals, including medical colleges from some States, as shared by
the Ministry of Health and Family Welfare, Government of India, across 36 States and Union
Territories were part of the assessment conducted in 2018–19. For this assessment, the HMIS data
of district hospitals for the financial year 2017–18 was taken as baseline, which was validated
Best Practices in the Performance of xvii

Executive Summary
against the physical records maintained by the hospitals. The validation exercise was conducted
by the National Accreditation Board for Hospitals and Healthcare Providers (NABH). It involved
onsite review of medical records of all district hospitals — the registers from where data was
collated and entered in the HMIS portal were reviewed for the purpose of the audit. The validation
exercise revealed that on average, there was a 75% match between the data in the physical
records and that entered on HMIS. The most common reasons for a mismatch between the
two data points included difference in the understanding of definitions of various indicators,
lack of continuity in data capture and data entry in HMIS, and ambiguous indicator definition.
Key Findings
The regional variance across states in the country was evidently visible in the top performing
hospitals across indicators. District hospitals from almost every state and union territory have
fared well in one or the other indicator. For the KPI “No. of functional hospital beds per 100,000
population” it is seen that on an average a district hospital in India has 24 beds per 1 lakh
population. The Indian Public Health Standards (IPHS) 2012 guidelines recommend district
hospitals to maintain at least 22 beds per 1 lakh population (based on district population average
of 2001 Census). District hospitals in India have a range of 1 to 408 beds per 1 lakh population.
217 district hospitals were found to have at least 22 beds for every 1 lakh population. Less
populated districts have been seen to fare well in infrastructure-related KPIs, while the more
populated districts in the states of Uttar Pradesh, Maharashtra, etc. have obtained higher scores
in KPIs such as bed occupancy rates and number of surgeries per surgeon.
Hospital support services, such as a hospital information system, blood bank, waste management,
complement clinical services indirectly contribute to better health outcomes. Based on IPHS
(2012), the assessment framework identified 14 support services that a district hospital is
expected to maintain. It was found that a district hospital in India has 11 support services on
an average. A total of 89 district hospitals were found to have provision of all the 14 support
services. With regard to availability of core health care services, 101 district hospitals were
found to have provision of all 14 core health care services. On average, a district hospital in
India has 10 core health care services. As for availability of diagnostic testing services, 21 district
hospitals were found to have provision of all 14 diagnostic testing services; 14 of which are large
hospitals (those having more than 300 beds). On average, a district hospital in the country
has 9 diagnostic testing services, while large district hospitals have an average of 11 services.
One of the means of determining the efficiency of a district hospital is its bed occupancy rate.
The average bed occupancy rate in district hospitals in India is 57%. IPHS guidelines for district
hospitals (2012) recommend at least 80% bed occupancy. 263 district hospitals were found to
have a bed occupancy rate of more than 80%, of which 54% were small hospitals (those with
200 or less beds), 19% were mid-sized hospitals (those with 201–300 beds), and 27% were
large hospitals (those with more than 300 beds). Of these 263 hospitals, the largest share
(16%) is occupied by district hospitals in Uttar Pradesh, followed by Madhya Pradesh (9%), and
Maharashtra (8%).
District hospitals have been employing unique initiatives in different arenas in order to improve
their service delivery. For instance, Belgaum district hospital, Karnataka has an impressive blood
bank replacement rate of 0% (0 blood units issued on replacement). The hospital team achieved
this by focusing on the importance of counselling and convincing potential donors to become
regular donors, thereby ensuring availability of blood units in the blood bank.
xviii Best Practices in the Performance of

Executive Summary
JLNM Hospital in Srinagar was found to have a high C-section rate. They followed a
multidisciplinary approach to effectively improve on existing infrastructure and manpower,
including gynaecologists, medical officers, nursing staff and other support staff who were
available round the clock. Integrating the health infrastructure with sufficient support services,
availability of fully functional blood bank and special newborn care unit (SNCU) helped clinicians
in managing high risk delivery cases in the hospital.
This report shares some of the best practices adopted by the district hospitals that obtained
the highest scores in each of the indicators. It is hoped that states and districts would be able
to learn from one another. An institutional mechanism that helps build capacity and sustain
these practices would be useful.
The need for strengthening the public health information system cannot be emphasized enough.
It involves better data management, regular data validation and periodic inspections, such as this
performance assessment exercise. To ensure quality and timely health information, adequate,
trained and dedicated human resources must be provided. An increase in awareness of the
importance of HMIS portal following this exercise provides an ideal opportunity to strengthen
public health information systems in the country.
The overall objective of this exercise has been to assess the performance of the district hospitals
on pre-determined Key Performance Indicators (KPIs) and repeat it annually to capture the
change. An annual assessment of district hospitals can serve as a valuable resource that can
help them improve their performance. It will also foster a sense of healthy competition and
provide an opportunity to showcase progress. It will further help to objectively assess how
efficiently the resources are being utilized and thus help improve delivery. Importantly, it will
provide greater confidence in the quality of data and serve as a tool to track crucial health
care indicators more efficiently.
Many of the variables included in the exercise, however, are input based indicators that reflect
the health of the hospitals indirectly. As the exercise evolves, more indicators, which directly
represent the health outcomes and reflect the quality of services that are being delivered at
public health facilities, could be included.
This exercise highlights the importance of accurate and quality data reporting and is expected
to lead to improved HMIS data. It is anticipated that this would encourage policymakers and
programme managers using HMIS data to undertake real-time programme evaluation, course
correction and evidence-based policy formulation.
It is hoped that the information will be used by the states and districts to improve their
service delivery and thereby, improve performance on health outcomes. It will also foster
healthy competition and motivate district hospitals and states to take corrective measures,
where needed. Overall, the findings of this first-ever facility-based comprehensive exercise for
measuring performance is expected to prove extremely valuable for more informed policy
formulation and strategic planning for better health outcomes.
Best Practices in the Performance of xix

Executive Summary
xx Best Practices in the Performance of

1
Introduction to
District Hospitals:
The Centrepiece
of the Health Care
Delivery System
Introduction to District Hospitals: The Centrepiece of the Health Care Delivery System
1.1 PUBLIC HEALTH CARE IN INDIA

India has made significant progress in improving its health outcomes over the last two decades.
Many key indicators, however, continue to show considerable scope for improvement. We now
need to build on the many opportunities to respond to the growing aspirations and needs of
a new India. The National Health Policy 2017 envisages strengthening the health system and
investing in health and the organization of health care services.1
Policy making in the country’s health sector is shaped by its federal structure and the Central–
State divisions of responsibilities and financing. Public health and sanitation, hospitals and
dispensaries are state subject, which means the primary responsibility of their management and
service delivery lies with the states. However, the Centre also invests in health services through
Centrally Sponsored Schemes such as the National Health Mission (NHM) and Ayushman Bharat.
The Centre plays an important role in vital statistics, medical education, and drugs administration,
among others, which are subjects in the Concurrent List, as also in planning, policy making, and
funding for public health at state and national levels.
public h
red ea
ie
t
lth
3-
I nd ia’s
system
PRIMARY SECONDARY TERTIARY

HEALTH CARE HEALTH CARE HEALTH CARE
Health and Wellness Centres (HWC) District Hospitals Medical colleges & advanced
medical research institutes
Sub-Centres (SC) Sub-District Hospitals
Specialised Intensive Care Units
Primary Health Centres (PHC) Community Health Centres
(CHC) at block level Advanced diagnostic support services
Specialists (gynaecologists, Specialised medical personnel

pediatricians, surgeons) posted
at CHC and DH
Figure 1: India’s three-tiered public health system
As shown in Figure 1, the public health care infrastructure in India has been developed as a
three-tier system:
Primary health care provides the first level of contact between the population and
health care providers. It has three types of health care institutions, namely, sub-centre
(SC), primary health centre (PHC) and, more recently, Health and Wellness Centre
(HWC).
1 National Health Policy 2017, Ministry of Health and Family Welfare, Government of India
2 Best Practices in the Performance of

Secondary health care refers to a second tier of health system, in which, patients
from primary health care are referred to higher hospitals for treatment. In India, the
institutions for secondary health care include district hospitals, sub-district hospitals,
and community health centres at the block level.
Tertiary health care is the third level of health system that includes specialized
consultative care, provided mostly on referral basis, from primary and secondary
health care. Tertiary care service is usually provided by medical colleges and advanced
medical research institutes.
The NSS reports on the key indicators of social consumption of health in India2 throw light
on the care-seeking behaviour of the Indian population. Table 1 shows the distribution of
hospital services accessed in the outpatient and inpatient departments with respect to type of
demography (rural/urban) and service provider (public/private). The epidemiological transition
of disease burden and the country’s commitment towards achieving Universal Health Coverage
(UHC) has witnessed rapid growth in the health care sector. This is duly reflected in the roll-out
of the world’s largest social protection scheme, Ayushman Bharat.3
Table 1: Distribution of hospital services accessed in India
Share of ailments treated in the outpatient Share of ailments treated in the inpatient
department by sector and demography department by sector and demography
Rural Urban Rural Urban

2014 2017–18 2014 2017–18 2014 2017–18 2014 2017–18

Public Public
28.30% 32.50% 21.20% 26.20% 42.00% 45.70% 32.00% 35.30%
facilities facilities
Private Private
71.70% 67.50% 78.80% 73.80% 58.00% 54.30% 68.00% 64.70%
facilities facilities
Source: NSS 71st and 75th rounds, NSSO, Ministry of Statistics and Programme Implementation
Taking into account the needs of health care in the country, the government has made ambitious
global and national commitments to improve health outcomes.
For India to keep its global commitment, we need to measure and evaluate how its existing
public health ecosystem, including district hospitals, is performing.
1.2 TOWARDS IMPROVED HEALTH OUTCOMES — SDGS AND

AYUSHMAN BHARAT
India has made creditable progress over the last two decades on many fronts, including
elimination of polio, maternal and neonatal tetanus and yaws, thereby improving health
outcomes, as also in reducing the disease burden of mothers and children. There has been a
2 NSSO, Key Indicators of Social Consumption in India: Health, NSS 71st (2014) and 75th (2017–18) rounds, Ministry of
Statistics and Programme Implementation
3 Press Information Bureau, Government of India, “Ayushman Bharat – Pradhan Mantri Jan Aarogya Yojana (AB-
PMJAY) to be launched by Prime Minister Shri Narendra Modi in Ranchi, Jharkhand on September 23, 2018” (https://
pib.gov.in/Pressreleaseshare.aspx?PRID=1546948)
Best Practices in the Performance of 3

significant decline in infant mortality between the years 2006 and 2018, from 57 to 32 per 1000
live births. Similarly, the maternal mortality ratio has dropped from 212 deaths per 100 000 live
births in 2007–09 to 113 deaths in 2016–18.4
As per the National Health Profile 2020, life expectancy in India has significantly increased
from 49.7 years in 1970-75 to 69 years in 2013-17. As a consequence, India today is in the
‘epidemiological transition’ phase, where it faces a dual burden on the disease, namely rising
burden of non-communicable diseases (NCDs) and the already existing burden of communicable
diseases. A holistic approach needs to be in place to address this epidemiological transition.
Two major drivers to improve health care outcomes for the country are the Sustainable
Development Goals (SDGs) and the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana.
While the former reflects the country’s aspirations and commitments, the latter represents the
government’s intent and action.
District hospitals have the potential to become valuable sources of information on how services
are rolled out for other aspects of secondary public health care, including NCDs. To tackle the
growing burden of disease and to provide quality primary, secondary, and tertiary health care,
India launched Ayushman Bharat, a centrally sponsored programme, in 2018, which aims to
provide free access to secondary and tertiary health care services for low-income earners in the
country. Under the programme, both public and private hospitals, including district hospitals are
empanelled to provide services to eligible beneficiaries.5 This makes it imperative to measure
and understand the current state of health at district hospitals in the country.
1.3 ROLE AND IMPORTANCE OF DISTRICT HOSPITALS

When patients reach any given district hospital, they expect that a doctor in the required
medical specialty would be available at the outpatient department (OPD) to diagnose and
treat their health disorder and prescribe tests and medicines, which can then be obtained at
the pharmacy in the hospital. If the doctor orders diagnostic tests, the patient can get them
done at a laboratory by a technician at that particular point of care. If the doctor recommends
admission, the patient can get a bed at the hospital. If a higher-level medical intervention,
such as surgery, is suggested, the patient can be operated upon within a reasonable period of
time. During the patient’s stay at the hospital, they are cared by the on-duty nurses. After the
surgery, the patient should recover without any infection. The hospital ecosystem is expected
to maintain acceptable levels of hygiene and cleanliness. These are the standard expectations
of any patient visiting a district hospital anywhere in the world.
All these essential components form links of a delicate health care chain that determines the
patient’s experience. Inefficiencies and inadequacies in any of the departments can frustrate
the patient and adversely impact the health outcomes and overall reputation of the hospital.
4 SRS bulletin, Office of Registrar General of India, Ministry of Home Affairs, Government of India
5 https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/ayushman-bharat-private-players-
to-get-a-role-in-running-district-hospitals/articleshow/66266577.cms

This assessment has considered a wide array of health indicators including number of beds,
doctors, nurses, and paramedical staff, availability of diagnostic and health care specialties,
bed occupancy rate, among others. Indicators were identified on the basis of certain aims
and objectives that needed to be fulfilled by a holistic assessment process. Indicators were
broadly classified under the domains of structure and output, and top and least performing
district hospitals in each indicator were identified.
For patients at the bottom of the economic pyramid, unavailability and inaccessibility of medical
attention and intervention at a public sector hospital could mean that their health issues are
unaddressed. This could affect their productivity and in turn cost them loss of wages, pushing
them into the vicious cycle of poverty and unemployment. This unaddressed illness and sub-
optimal productivity, when faced by a significant size of the population, has the potential to
negatively impact the country’s economy to grow sustainably.
In the three-tier structured level of public health care, the district hospital forms an integral and
vital part of the health care delivery system. It functions as a secondary level of health care,
which provides comprehensive preventive, promotive, and curative health care services to the
people in the district.
A total of 810 district hospitals across India provide critical services to the population.6
Each district hospital is linked with public hospitals/ health centres such as the community
health centre (CHC), the primary health centre (PHC), and the sub-centre (SC).
As per the Indian Public Health Standards (IPHS), district hospitals are mandated to:
provide comprehensive secondary health care (specialist and referral services) to the
community;
achieve and maintain an acceptable standard of quality of care; and
make services more responsive and sensitive to the needs of the people of the district
and the hospitals/centres from where the cases are referred.
Key elements governing the functioning of district hospitals:
Affordability. Provide effective, affordable health care services (curative including

specialist services, preventive, and promotive) for a defined population.
Accessibility. At least one district hospital for every district providing advanced
secondary care.
Extensive coverage. Service coverage encompassing both urban (district headquarter
town) and the rural population in the district.
Broad scope. Provide wide-ranging technical and administrative support and education
and training for primary health care.
6 As on 31st March 2020, Rural Health Statistics, 2019–20.

Substantial infrastructure. The district hospital, having beds ranging from 100 to 1200,
provides out and inpatient critical services including surgical interventions such as
caesarean sections; care for sick newborns, infants, and children; management of NCDs
and infectious diseases; and blood storage facility on a 24-hour basis.
Contribution to society. District hospitals have a lot to contribute towards meeting the
country’s global and national goals and targets, including the SDGs, and thus improving
health outcomes.
1.4 ROLE OF A ROBUST HEALTH MANAGEMENT INFORMATION

SYSTEM (HMIS)
To make health services more responsive and sensitive to the needs of the people, there must
be a robust health information system that tracks the progress and on-ground activities in a
systematic manner. In recognizing this, India launched HMIS in 2008 to capture comprehensive
health information on input, output, outcome, and impact indicators from sub-centres, PHCs,
CHCs, and district hospitals. These were fed into standardized formats in a web-based system.
The system was initially launched with the idea of uploading district-wise consolidated figures
but has since evolved to serve as an important source for evidence-informed policy.
HMIS captures facility-wise information on formats framed in close consultation with

programme divisions under the Ministry of Health and Family Welfare (MoH&FW) and other
stakeholders. The data is being utilized in grading health facilities, identification of aspirational
districts, and review of state programme implementation plans (PIPs), among others.
The information generated from HMIS serves as evidence for analysis, which helps shape policy
and strengthens programme interventions. It is a valuable tool that grades health facilities,
identifies aspirational districts, and reviews state PIPs. Further, it is used by the Central/ State
governments to monitor and supervise the different functions that make up the public health
system. These HMIS formats are designed to capture data on a set of indicators that are vital
to track and measure performance of health programmes. A brief summary of the indicators
on which data is collected and the frequency with which the reports are generated can be
seen in Annexure 1.
Uploading facility-wise data on the HMIS web portal:

More than 200,000 health facilities upload the data, out of which 95 per cent are public
health facilities.
On a monthly basis, facility-wise service delivery data is uploaded by these health facilities
On a quarterly basis, training data is collated
On an annual basis, infrastructure related data is collated
Notwithstanding the importance of the HMIS database, there have been observations about the
limitations of the quality and the scope of data that the health information system generates.
One of the concerns expressed is that the health outcome statistics generated through this
system are not representative of the population as all private sector data is not being reported

in the HMIS portal. Another issue that has been flagged is that despite the hospitals generating
a wealth of information internally, the same does not always get fully reflected in the national
database.
These factors and concerns around on-ground validation of data have led to a need to deepen
the understanding of how public health units fundamentally function and what is the experience
that the patient takes home from these hospitals and clinics. Are the patients able to access
doctors? Get essential drugs? Undergo surgeries when needed? These are some of the questions
that need to be answered. From these realizations, germinated a seed of thought — India must
evaluate the health of its district hospitals, and assess their performance.
Robust estimation of health care indicators and studying their trends over time at the district
level would help strengthen the health information systems and also prove valuable for
informed policy formulation and improved health care delivery.
A robust estimation of different health care indicators and studying their trends and patterns over
time at the district level would be useful to understand intra-state variations. A comprehensive
assessment of these trends in the health care indicators, and their association with policy
targets, would prove valuable to inform and improve health care policy formulation and decision
making at all levels.
1.5 GLOBAL PRACTICES IN HOSPITAL PERFORMANCE

ASSESSMENTS
Performance indicators being a useful mechanism in measuring the quality of service, it has
become a popular means in many arenas to use them in facilitating both improvement and
efficient management. In the health sector too, there are well established systems of comparing
health systems cross-nationally on multiple dimensions. Performance indicators are a dynamic
concept that evolve with time, as it cannot ignore changes and evolution that occur in the health
sector. WHO and global partners have developed a Health Systems Strengthening framework
for a comprehensive assessment of components such as service delivery and health workforce.7
Within this framework, of a set of indicators are measured — for example, the number of
functional beds with respect to population is an important indicator in measuring the levels of
access to hospital inpatient services, identifying areas with disproportionate number of beds,
and allowing for comparisons within and between countries, regions, sectors, and programs.
Similar to health systems, the hospitals and health care delivery systems of different countries
are also evaluated on certain indicators. For instance, the number of beds available in a hospital
with respect to its population size — WHO recommends that for every 1,000 people there
be at least 5 beds. The Indian Public Health Standards (IPHS) recommends district hospitals
in India to maintain 220 beds per 10 lakh population.8 In the same manner, other indicators
such as bed occupancy rate, availability of doctors and other medical staff, admission rates,
patient satisfaction, among others, are also recommended and measured. These indicators
reflect the functioning of the health systems but do not represent the performance of health
7 World Health Organization, Strengthening Health Systems to Improve Health Outcomes: WHO’s Framework for
Action, 2007.
8 Indian Public Health Standards (IPHS), Guidelines for District Hospitals, 2012

care institutions (hospitals) per se. While independent studies may measure the performance of
hospitals in a region (e.g., the Times Health All India Multispecialty Hospitals Ranking Survey),
there is no standard framework that helps assess and compare hospital performance on a set
of uniform parameters.
NITI Aayog undertook an in-depth study of domestic and international health systems in order
to develop a holistic framework to assess the overall performance of district hospitals in India
in a uniform manner. The salient features of these systems are included in Annexure 2. The
following chapter highlights the indicators used in the study and the methodology in assessing
district hospitals’ performance.

2
Rationale and
Approach for
the Performance
Assessment of
District Hospitals
Rationale and Approach for the Performance Assessment of District Hospitals
2.1 PROJECT BACKGROUND
Public health experts have questioned the limited use of administrative data generated in the
country and, at times, its quality. For instance, the country makes use of the sample registration
system (SRS) and National Family Health Surveys (NFHS) for data on maternal mortality ratio
(MMR), infant mortality rate (IMR), under-5 mortality rates, total fertility rates (TFR), and other
important indicators in the absence of complete Civil Registration and Vital Statistics (CRVS)
system.
Further, key outcome measures like IMR, MMR, etc. through the SRS system are limited to
the state level and do not provide information about district-level variations. However, the
public health care system is organized for service delivery at the district and sub-district level.
Therefore, outcome-based measures of system functioning at the district level are needed to
help programme managers prioritize and tailor their implementation at the local level.
Assessing the performance of district hospitals across the country on a uniform set of key
indicators can serve as a valuable resource that can help identify where the hospitals stand in
terms of their service delivery and what are the gaps contributing to any under-performance.
This will also help study why these gaps exist and how they can be addressed. Undertaking
such an exercise annually will help foster a sense of healthy competition between the individual
district hospitals and provide them an opportunity to showcase progress against relevant
indicators, such as health information systems, stockouts, and functional beds, among others.
This calls for a robust, trustworthy facility-generated data ecosystem and reporting. Large
funding allocations to district hospitals to provide critical secondary care services to the
community, as well as their critical role in health care delivery, calls for a comprehensive system
of assessment of district hospitals.
Having an annual exercise to validate existing data as well as to collect fresh data from the
fundamental unit of the public health care system should allay misgivings about the quality of
routine, administrative data. It would also help policy makers to find an essential tool to track
many crucial health care indicators on a regular basis and assess whether or not the data
reported in the government’s existing health information system is reflecting the correct picture
on the ground.
The Indian Public Health Standards (IPHS) is a set of uniform standards envisaged to improve
the quality of health care delivery in the country. They came into existence in the year 2007
and were revised in 2012.last revised in 2012. The guidelines are currently being reviewed and
the updated guidelines are expected to be released by the National Health Systems Resource
Centre. They provide benchmarks for assessing the functional status of hospitals. The MoH&FW
is increasingly nudging hospitals to adopt these standards for providing optimal care to the
community.
2.2 OBJECTIVES OF THE PROJECT

To assess the performance of district hospitals vis-à-vis selected Key Performance
Indicators (KPIs)
To disseminate the best practices of well performing district hospitals, so that other
hospitals in the country may follow similar interventions to improve their performance
and thereby improve health outcomes

2.3 MEASURES USED IN THE ASSESSMENT

The assessment looked at a wide array of health indicators ranging from beds, doctors, nurses,
paramedics, diagnostic and health care specialties available to bed occupancy rates, caesarean-
section surgeries, and blood bank replacement rate. Annexure 2 gives a summary of the health
systems studied in order to create a suitable framework for assessment. A total of 10 KPIs were
identified to assess the ecosystem and performance of district hospitals in all the States and
Union Territories (UTs). The KPIs were designed by NITI Aayog in consultations with multiple
stakeholders namely, the MoH&FW, the States of Punjab, Maharashtra, Uttar Pradesh, Assam,
and Tamil Nadu, and specialist agencies like World Health Organization and Bill and Melinda
Gates Foundation. After sharing them with all States/UTs for seeking feedback, the KPIs were
then finalised in November 2016 by a working group comprising JS (Policy) MoH&FW, Adviser
(Health) NITI Aayog, Principal Secretary – Health & ME (Punjab), and WHO representative.
The KPIs were identified on the basis of certain aims and objectives that needed to be fulfilled
by a holistic assessment process. They were broadly classified into two categories — structure
and output. Five of these 10 KPIs estimated the level of infrastructure which the district-level
hospitals had, and the remaining indicated the outputs that these hospitals were generating. A
list and description of the indicators is given in Table 2.
Table 2: List of Key Performance Indicators (KPIs) to assess district

hospitals
Domain Category* Key Performance Indicator
A 1. Number of functional hospital beds per 100,000 population
2. a. Ratio of doctors in position to IPHS norm;

A b. Ratio of staff nurses in position to IPHS norm;
Structure c. Ratio of paramedical staff in position to IPHS norm
B 3. Proportion of support services available
A 4. Proportion of core health care services available
A 5. Proportion of diagnostic services available
B 6. Bed occupancy rate
B 7. C-section rate
Output B 8. Surgical productivity index
B 9. OPD per doctor
B 10. Blood bank replacement rate
*Note: C
ategory A indicators are those that are largely under the control of the State, while Category B indicators are
those that are largely under the control of the district hospital

2.4 CATEGORIZATION OF HOSPITALS FOR ANALYSIS

For meaningful analysis and comparison, district hospitals were categorized according to their
bed strength, thereby enabling comparison of similar-sized hospitals. Therefore, for the purpose
of the assessment, district hospitals having up to 200 beds were referred to as small hospitals;
those with more than 300 beds were called large hospitals; and those with 201 to 300 beds
were referred to as mid-sized hospitals (Table 3).
Table 3: Categorization of district hospitals

Hospital Category Criteria
Small hospital District hospital having up to 200 beds
Mid-sized hospital District hospital having 201 to 300 beds
Large hospital District hospital having more than 300 beds
2.5 PROCESS FOR CONDUCTING ASSESSMENT

Pre-assessment phase. As stated above, NITI Aayog, the Ministry of Health and Family Welfare
(MoH&FW), and World Health Organization (WHO) developed a framework for a comprehensive
assessment of district hospitals with a set of KPIs finalized in consultation with States and UTs
and other key stakeholders. Thereafter, the National Accreditation Board for Hospitals and
Healthcare Providers (NABH), a constituent board of Quality Council of India (QCI), was selected
as the external data validation agency through a competitive bidding process.
The Statistics Division of MoH&FW finalized and shared the HMIS data of all district hospitals
with NITI Aayog for the year 2017-18. NABH in consultation with NITI Aayog, the National
Health Systems Resource Centre (NHSRC) and the Statistics Division from MoH&FW, and Indian
Statistical Institute (ISI) designed a questionnaire based on the numerator and denominator
variables of the KPIs. The questionnaire was field-tested and developed into a mobile application
(survey instrument) for onsite data collection of 56 data items mapped to the KPIs.
Training phase. The NABH assessors (medical professionals from various health institutes in the
country) were trained on the overall project, questionnaire, and methodology of the assessment.
As many as 17 training workshops were conducted across the country and more than 400
assessors trained.
Assessment phase (data collection). The assessors conducted the onsite review of primary
records of district hospitals and validated the observed data with the corresponding HMIS
data for each hospital. The responses were collected through a mobile application (survey
instrument). A backend quality team from the NABH office was mapped to each assessor for
guidance on the day of the assessment. The team monitored the assessment live and flagged
the response/ evidence in case of any discrepancy. To ensure that the data collected was
appropriate, multiple levels of quality check of assessments were undertaken. At the time of
assessment during the period 2018–19, a total of 731 district hospital across 37 States/UTs were
part of the on-ground data collection and validation exercise. Of these, 24 hospitals could not
be assessed due to security issues and difficult terrain. In effect, 707 (97%) district hospitals
were assessed for data validation by the NABH assessors.

Post-assessment phase (data validation and analysis). After assessment, the data collected
was cleaned to identify and analyse variation between onsite collected data and HMIS data.
NITI Aayog shared this cleaned data with the respective States/UTs and conducted a video
conference between them and the validation team (NABH and MoH&FW Statistics Division)
to validate the reviewed data. In case the States/UTs disagreed on any of the data points that
were collected and shared by NABH, they were given an opportunity to submit corrected data
with evidence within a stipulated time period. The submitted data was then examined by NABH
and incorporated in the final database, which was used for the evaluation of KPIs.
2.6 KEY RESULTS OF DATA VALIDATION

For the 707 hospitals assessed for data validation, the average percentage of match between
the onsite collected data and its corresponding HMIS entry was 75 per cent. Many reasons were
cited for the 25 per cent average mismatch, some of the most common being difference in
understanding of definitions of various indicators, lack of continuity in data capturing and data
entry in HMIS, ambiguous indicator definition, among others. These are elaborated in detail in
Chapter 4.
Methodology for evaluation of percentage of match in data

The findings of the data validation exercise are based on the match/mismatch found between
the assessor-observed value (onsite validated data) and the corresponding value entered in
the HMIS portal. District hospital-wise response to each validated data for the 56 questions
(HMIS data points) was compared with their corresponding pre-entered HMIS value. Based
on this, a specific percentage of match was calculated for each district hospital. For example,
if a match was found between the onsite validated data and its corresponding HMIS data
entry for 49 out of 56 questions for a particular district hospital, then the percentage of
match for that hospital becomes 88 per cent (=49/56*100).
State/UT-wise average percentage of match (Figure 2a) between the onsite validated data
and its corresponding HMIS values was calculated by taking the average percentage of
match of each district hospital falling under that State/UT.
Indicator-wise percentage of match (Figure 2b) was calculated by taking the percentage
of the total count of match observed for that indicator across the total hospitals assessed
(N=707). For example, the assessor-observed value for the question, ‘Is General Surgery
service available?’ matches with its corresponding HMIS data entry in 576 of the 707 district
hospitals. Hence the percentage of match for the indicator across the district hospitals is
81 per cent (=576/707*100).
Percentage of match: State/UT-wise and indicator-wise

State-wise, Goa showed the maximum percentage of match (87%) while Mizoram showed
the least match (63%) between onsite validated data and pre-entered HMIS values. In the
case of UTs, Dadra and Nagar Haveli showed a 100% match, while Lakshadweep had the least
percentage of match (41%). Most of the district hospitals fell in the range of 65%–85% of match
(see Figure 2a). With regard to indicator-wise percentage of match, the components under the
core health care services showed maximum match, while the human resource component of the

indicators showed the least match in all the States/UTs, with number of paramedical staff having
the least percentage of match (see Figure 2b). This may be attributed mainly to difference in
definitions of the medical staff as understood by the hospital vis a vis definition of HMIS.
100
91
87
86
84
83
83
83
80
81
81
79
79
78
78
77
77
77
77
76
76
76
76
74
74
73
73
70
71
68
68
65
64
63
62
42
41
Chhattisgarh
Uttarakhand
Tamil Nadu
West Bengal
Odisha
Arunachal Pradesh
Chandigarh
Nagaland
Bihar
Punjab
Goa
Meghalaya
Daman & Diu

Tripura
Kerala
Jammu & Kashmir

Gujarat
Ladakh
Assam
Maharashtra
Madhya Pradesh
Andhra Pradesh
Karnataka
Telangana
Puducherry
Haryana
Delhi
Rajasthan
Sikkim
Himachal Pradesh
Mizoram
Lakshadweep
Uttar Pradesh
Manipur
Jharkhand
A & N Islands
Dadra & Nagar Haveli
Figure 2a: State/UT-wise percentage of match between NABH onsite validated data and
corresponding HMIS values
2.7 COMPUTATION OF KPI SCORES

While the data validation exercise was crucial in determining the validity of the data entered
in the HMIS portal, this assessment is based on the onsite validated data collected by the
assessors. In order to assess the performance of district hospitals, the formula of each KPI was
defined (see Annexure 3). The raw score for each KPI of each district hospital was calculated
accordingly and then sorted to identify well-performing and least-performing hospitals for each
indicator. Top performing hospitals in each hospital category (small, mid-sized, large) for each
individual KPI were identified so as to learn the best practices they have adopted with respect
to those indicators. The best practices of these top performing district hospitals were sought
from the respective state and/or district-level officials.

Is Pharmacy available in the hospital? 97

Is Dental Care service available? 96
Is Obstetrics and Gynaecology service… 96
Is Urine Analysis service available? 94
Is Anaesthesia service available? 94
Is Emergency service available? 94
Is Medico-legal/post mortem service available? 94
Is Ophthalmology service available? (core) 94
Is Waste management service available? 94
Is ENT service available? (core) 93
Is Engineering service available in the hospital? 93
Is Orthopaedics service available? 93
Is Blood Bank available? 92
Is Hospital Transport Ambulance available? 92
Is Water supply service available in the hospital? 92
Is refrigeration service available in the hospital? 92
Is Haematology testing service available? 90
Is Sputum testing service available? 88
Is Pediatrics including Neonatology service… 87
Is Radiology service available? (diagnostic) 87
Is Ophthalmology service available?… 87
Is Biochemistry service available? 86
Is dietary service available in the hospital? 86
Is ENT service available? (diagnostic) 86
Is Endoscopy service available? 85
Is Radiology service available? (core) 85
Is Dermatology and Venereology service… 83
Is CSSD service available? 83
Is General Surgery service available? 81
Is Serology service available? 78
Is Critical Care (ICU) service available? 77
Is Stool Analysis service available? 77
Is Physiology (Pulmonary Function Test)… 77
Is General Medicine service available? 76
Total number of C-section deliveries… 74
Is Microbiology service available? 71
Total number of Ayush-Outpatient attendance 71
Is Cardiac Investigation service available? 71
Total number of deliveries performed in a year 70
Is PAP Smear service available? 68
Is Public Health Unit service available? 67
Is HIS implemented-OPD? 64
Is HIS implemented-Pharmacy? 63
Total number of blood units issued on… 61
Number of functional beds 61
Is HIS implemented -Complete HIS? 59
Total number of Allopathic-Outpatient… 55
Total number of blood units issued in a year 55
Total number of inpatient bed days in a year 54
Is HIS implemented-IPD? 54
Total number of OPD patients in a year 50
Total number of major surgeries in a year 46
Total number of surgeons positioned 36
Number of doctors positioned 27
Number of staff nurses positioned 22
Number of paramedicals positioned 11
Figure 2b: Indicator-wise percentage of match between NABH onsite validated data and
corresponding HMIS values


3
Assessing District
Hospitals with
respect to the
Key Performance
Indicators (KPIs)
Assessing District Hospitals with respect to the Key Performance Indicators (KPIs)
As per the framework, for the purpose of the analysis, hospitals were categorized on the basis
of bed strength (see Table 3). Of the total 707 hospitals assessed, about 62% (438) were small-
sized hospitals. The number of small hospitals was three times the number of large hospitals,
which constituted 21% (149) of the total. Mid-sized hospitals constituted only 17% (120) of the
district hospitals (Figure 3a).
Small (Up to 200 beds) Large (201-300 beds)

438 149
62.0% 21.1%
Mid-sized (More than 300

beds)
120
17.0%
Small (Up to 200 beds)

Mid-sized (200 - 300 beds)
Large (More than 300 beds)
Figure 3a: Distribution of hospitals by size
Large states represent a larger share of districts hospitals in the country and smaller states
and UTs have a smaller proportion of district hospitals. It is notable that Uttar Pradesh, with
75 districts has 150 district hospitals which is over 21% of the total district hospitals (Figure
3b). Each district in Uttar Pradesh has separate district hospitals for women and children
and general hospitals. Therefore, each district hospital is split into two distinct hospitals with
separate infrastructure and service delivery and reported as separate facilities in the HMIS portal.
Uttarakhand, with only 2.55% of district hospitals, also has separate hospitals for women and
children and separate general hospitals in each district.
This chapter provides an overview of the performance of district hospitals in India with respect
to each KPI. The importance of each of KPIs included in the assessment is explained, followed by
insights based on the data, and best practices of well-performing district hospitals. Further, the
top performing district hospital in each State/UT in individual KPIs has been listed in Annexure
4. Annexure 5 includes graphs illustrating the State/UT-wise average raw score of each KPI
for each hospital category (small, mid-sized, and large). The KPI-wise raw scores of all district
hospitals that were part of the assessment are given in Annexure 7.

Uttar Pradesh Karnataka Rajasthan Assam Maharashtra Jharkhand Punjab
5.66%
Bihar 3.82% 3.54% 3.54% 3.25% 3.11%
Gujarat Jammu & Delhi Haryana Uttarakhand

Kashmir
2.97%
5.09%
Kerala
Odisha Puducherry
2.69% 2.55% 2.55% 2.55% - 0.57%
Sikkim
2.97% Andhra Mizoram Tripura
- 0.57%
Pradesh
21.22% West Bengal A & N Islands
1.13% - 0.42%
4.53% 0.85%
1.98% Manipur Nagaland
Madhya Pradesh - 0.42%
Tamil Nadu Himachal
2.83% 0.99% Daman &
Pradesh
Arunachal Diu -0.28%
Chhattisgarh 1.56% Pradesh Ladakh - 0.28%
0.85%
Meghalaya Chandigarh
Telangana - 0.14%
7.21% 4.53% 2.69% 1.27% 0.85% Lakshadweep
- 0.14%
Goa -0.28% Dadra & Nagar Haveli - 0.14%
Figure 3b: Distribution of district hospitals by State/UT

Best Practices in the Performance of
19
3.1 NUMBER OF FUNCTIONAL BEDS PER 100,000 POPULATION
3.1.1 Definition of the KPI

A hospital bed constitutes the primary unit of any hospital infrastructure. The number of
functional hospital beds are of fundamental importance to both the patients and staff. This KPI
lies in the domain of structure and is largely under the control of the state. It refers to hospital
beds which are regularly maintained and staffed and immediately available for the care of
admitted patients. It specifically refers to the number of functional hospital beds in a district,
available for every 1 lakh people in that district. It includes beds available within the hospital
for admissions but excludes floor beds, trolley beds, labour room/operation theatre (OT) tables
and observation beds in emergency/OT/labour room. It is calculated by dividing the number of
functional hospital beds by the population of the district, multiplied by 100,000.
Number of functional beds per Number of functional hospital beds

= × 100,000
100,000 population Population of the district
3.1.2 Significance of the KPI in evaluating a district hospital

One of the important aspects under public health planning is providing the population with
the necessary bed stock. Knowing the number of beds in proportion to the population helps
understand resource availability of the district hospital in comparison to other districts or states.
A shortage of available beds can seriously impact how a hospital functions, as it is the primary
cause of denial of admission, surgery cancellations, and delays in emergency admissions.
Conversely, excess bed capacity may lead to additional costs and stagnant capital. Moreover,
the sub-optimal utilization of resources is not ideal when public health care is facing a resource
crunch. Overall, population is the most important factor to take into account for hospital bed
capacity planning. Hospital capacity planning should consider hospital bed availability alongside
issues related to productivity, and clinical efficiency.9
This KPI is also useful in identifying resource allocation, such as requirement of staff, support
services, diagnostic testing facilities, etc. For example, in smaller hospitals in less-populated
districts, setting up a diagnostic testing lab for each hospital would not be optimal. In such
a case, two or three district hospitals may be combined to have such services and should be
supported by an efficient logistics system to transport biological samples.
3.1.3 Juxtaposition of the KPI with IPHS guidelines

WHO global standards recommend 5 hospital beds for every 1000 people. The World Bank 2017
data indicates that India has 0.5 beds for every 1000 people, which is inclusive of both public
and private hospitals. This report gives a picture of availability of functional hospital beds in
a district hospital only, which is a small sub-set of health care institutions in the public sector
9 Tian, F., & Pan, J. (2021). Hospital bed supply and inequality as determinants of maternal mortality in China between
2004 and 2016. Int J Equity Health, 20(1), 51. doi: 10.1186/s12939-021-01391-9
Carey, T. A., Wakerman, J., Humphreys, J. S., Buykx, P., & Lindeman, M. (2013). What primary health care services
should residents of rural and remote Australia be able to access? A systematic review of “core” primary health care
services. BMC Health Serv Res, 13, 178. doi: 10.1186/1472-6963-13-178

that also comprises SCs, PHCs, CHCS, as well as tertiary care institutions. The size of a district
hospital is a function of the hospital bed requirement, which in turn is a function of the size of
the population it serves. IPHS 2012 guidelines recommend a bed occupancy rate of at least 80%
in a district hospital serving a population of 10 lakh, which means the bed requirement in the
district hospital would be 220 beds (based on the assumptions of the annual rate of admission
as 1 per 50 population and average length of stay in a hospital as 5 days).10 Scaling it down
to the framework used in this study, a district hospital should have at least 22 beds for every 1
lakh population in order to cater to an 80 per cent annual bed occupancy rate.
3.1.4 District hospital performance and associated insights

Figure 3.1.1 shows State/UT-wise average number of functional beds in a district hospital per
1 lakh population. Puducherry had the highest average beds in the country, with a district
hospital in the UT having an average of 222 beds per 1 lakh population, while Bihar had the
lowest average of 6 beds per 1 lakh population. Taking the national average, a district hospital
in India has 24 beds per 1 lakh population (Figure 3.1.1). Annexure 5 includes graphs illustrating
the average number of functional beds per 1 lakh population by State/UT for each of the three
hospital categories — small, mid-sized, and large district hospitals.
Figure 3.1.2. shows the percentage of district hospitals in a State/UT that meet the IPHS
guidelines, 2012 of ensuring at least 22 beds for every 1 lakh population.
222
200
150
104
102
92
78
70
63
59
57
52
49
46
33
32
30
24
24
24
22
22
20
20
22
19
19
19
18
18
18
17
14
13
13
10
9
6
Nagaland
Odisha
Chandigarh
A & N Islands
India
Telangana
Ladakh
Daman & Diu
Delhi
Meghalaya
Karnataka
Goa
Tripura
Tamil Nadu
Assam
Uttar Pradesh
Mizoram
Manipur
Uttarakhand
Kerala
West Bengal
Gujarat
Maharashtra
Puducherry
Arunachal Pradesh
Chhattisgarh
Punjab
Sikkim
Himachal Pradesh
Andhra Pradesh
Jammu & Kashmir
Jharkhand
Bihar
Lakshadweep
Rajasthan
Haryana
Madhya Pradesh
Figure 3.1.1: State/UT-wise average number of beds in a district hospital for every 1 lakh
population
10 Indian Public Health Standards (IPHS), Guidelines for District Hospitals, 2012
Derivation of the number of beds required in a district with population of 10,00,000:
The total number of admissions per year = 10,00,000 × 1/50 = 20,000
Bed days per year = 20,000 × 5 = 100,000
Total number of beds required when occupancy is 100% = 100000/365 = 275 beds
A bed occupancy of 80% would mean utilisation of 220 beds (i.e., 275 × 80/100 = 220 beds)

Ladakh
Jammu and Kashmir
Himachal Pradesh
PunjabChandigarh
Uttarakhand
Haryana
Delhi Arunachal Pradesh
Sikkim
Rajasthan Uttar Pradesh

Assam
Nagaland
Bihar
Meghalaya
Manipur
Jharkhand Tripura
West Bengal Mizoram
Madhya Pradesh
Gujarat
Chhattishgarh
Odisha
Daman and Diu and Dadra and Nagar Haveli
Maharashtra
Telengana
Andhra Pradesh
Goa
Karnataka
Andaman & Nicobar
TamilnaduPuducherry
Legend
Kerala
India_State_Boundary
% of DHs with at least 22 beds per 1 lakh pop#
Lakshadweep
0.0- 10.7
10.7 - 31.3
31.3 - 46.8
46.8 - 77.8
0 87.5 175 350 525 700 77.8 - 100.0

Miles
Figure 3.1.2: Percentage of district hospitals in each State/UT that have at least 22 beds
per 1 lakh population
The district hospitals that have a higher number of functional beds for every 1 lakh population
in comparison to the rest of the hospitals in the country are indicated in Table 4. The top
performing district hospital in each State/UT for this KPI is listed in Annexure 4.
Table 4: Top performing district hospitals in the country for the KPI
“Number of functional beds per 100,000 population”
Small hospitals Mid-sized hospitals Large hospitals
Govt. General Hospital, Mahe, Leh DH, Leh Ladakh, Govt. General Hospital, Karaikal,
Puducherry Ladakh Puducherry
(409 beds per 1 lakh population) (187 beds per 1 lakh population) (252 beds per 1 lakh population)
BJR Hospital, Nicobar, Tomo Riba Institute of Medical G.B. Pant Hospital,
Andaman and Nicobar Islands Science & Hospital, Papum South Andaman,
Pare, Arunachal Pradesh Andaman and Nicobar Islands
Govt. General Hospital, Yanam, Dharwad District Hospital FRU, DH SDN Hospital, Shahdara,
Puducherry Dharwad, Karnataka Delhi
National average: 24 beds per 1 lakh population

Range: 1 to 409 beds per 1 lakh population

BEST PRACTICES OF WELL PERFORMING DISTRICT HOSPITALS

The G.B. Pant Hospital in South Andaman, a large district hospital in the UT of Andaman
and Nicobar Islands, has dedicatedly increased the number of hospital beds in line with the
increasing population of the district overtime. Development of infrastructure in existing and
new medical facilities, and addition of new specialties have further increased the number of
functional beds.
Despite being in a less populated district of Nicobar, the BJR

Hospital has perceptively increased hospital beds in the last few
years and assigned them to specific disciplines. This has ensured
optimal performance by the hospital, especially after the COVID-19
pandemic.
—Director of Health Services

Andaman and Nicobar Islands
Tomo Riba Institute of Medical Science & Hospital, Papum Pare, Arunachal Pradesh, which
is the only tertiary care hospital in the state, has gradually expanded existing infrastructure
and manpower requirements to cater to the increasing population. Strengthening of existing
services, regular staff training, adequate fund provision owing to the state government’s political
will have all contributed to increased service utilization and service delivery. The hospital now
provides medical services in all general disciplines and in super-specialty care in Cardiology,
Oncology, Paediatric Surgery, Plastic Surgery, and even in AYUSH.
Leh District Hospital in the UT of Ladakh serves as the main referral hospital for the whole
district, including the neighbouring district Kargil. During summer there is an influx of tourist
and labourers. To accommodate every patient, more beds are being added wherever possible
so that no patient is neglected. For this reason, although this hospital is sanctioned 150 beds,
there are about 270 functional beds. This hospital is the only functional hospital in the district
at present. As such the intervention was necessary.
Three of the four district hospitals the UT of Puducherry are among the top performing hospitals
in the country in this particular KPI. In Government General Hospital, Karaikal, a separate block
for the Obstetrics and Gynaecology Department was sanctioned in 1998, and an eye block
was commenced in August 2004 to fulfil the public demand. During that period number of
bed strength had been sanctioned as 180 beds for Maternity Department and 90 beds for the
Eye Block. Moreover, the hospital caters to the needs of the public not only from the Karaikal
region but also from the neighbouring district of Tamil Nadu. In Yanam district of Puducherry,
the population was gradually increasing and the then 50-bedded hospital was inadequate to
cater to the patient load. Hence the hospital administration sought to increase the number of
beds and submitted proposals to the Directorate of Health. The Health Department sanctioned
a multi-storeyed building with 100 beds, which was completed in 2005. Super specialists from
Kakinada have been engaged on a weekly basis to support the existing services to benefit the
public. Health Melas are conducted to screen various diseases at the field level and then referred

to multi-specialty clinics in Yanam region. Similar interventions were undertaken in Government

General Hospital, Mahe. Public interest and political will were the key factors in contributing to
increased number of functional beds in the UT of Puducherry.
DH SDN Hospital, Shahdara, Delhi and Dharwad District Hospital FRU, Karnataka employed
similar proactive measures in addressing the demand–supply gap, and increased the bed
strength and manpower in line with state government provisions to cater to its population.
Recommendations for States/UTs

Having a sufficient and balanced number of beds for the population is important as
has been shown by the recent COVID-19 pandemic.
While the IPHS do not recommend allotting specialty-wise beds as it may lead to
suboptimal utilization, the hospital may determine specialty-wise beds depending
upon the number of patients denied admissions from the emergency department for
a particular specialty, as well as days when no elective admissions could be made
for the particular specialty from the outpatient department. Bed strength can be
planned in medium term based on local disease burden and its expected trajectory.
Once a district hospital is converted to a medical college, the number of beds for
each specialty is determined by MCI regulations.
Allotting beds as per specialty and demand would also help avoid multiple admissions
on a single bed (for instance, labour wards can be allotted higher number of beds
than other specialties). This will ensure the dignity of the patient, prevent cross
infection, and ensure hygiene.
An annual audit of the out-patient and emergency footfalls should be done to
recommend the necessary beds for the hospital.
Optimization of hospital beds is necessary not only in economic interests, but also
for efficient patient care, comfort, and outcomes. Opportunities should be explored
for providing a judicious mix of outpatient and inpatient care, improve efficiency and
quality of hospital care, as well as the necessity of forming a reserve of hospital beds
in case of natural calamities, pandemics, or other emergency scenarios, which may
increase the level of hospitalization of citizens in a short period of time.

3.2 RATIO OF DOCTORS, STAFF NURSES, AND PARAMEDICAL

STAFF IN PROPORTION TO IPHS NORMS

The Indian Public Health Standards (IPHS), 2012 lays down certain standards that may be used
as a reference point in health care infrastructure planning. Manpower requirement is determined
by bed strength, as indicated in Table 5.
Table 5: Total medical and paramedical manpower requirements as per IPHS
Cadre 100 Beds 200 Beds 300 Beds 400 Beds 500 Beds
Doctors 29 34 50 58 68
Staff Nurse 45 90 135 180 225
Paramedicals 31 42 66 81 100
Total Strength 105 166 251 319 393
Source: Guidelines for District Hospitals, IPHS, 2012
This KPI also lies in the domain of structure and the subject falls under the control of the state
rather than the district hospital. It is calculated by dividing the total number of positioned staff
by the minimum essential manpower required as per IPHS.
Positioned doctors include MBBS, BDS, and AYUSH specialists; for positioned staff nurses, the
post of Auxiliary Nurse Midwife (ANM) is excluded; for paramedical staff, all categories included
in IPHS have been considered.
Total number of positioned staff

Ratio of doctors/nurses/ paramedical =
Minimum essential manpower required
staff in position to IPHS norms
(see Table 5)

Increasing hospital admissions have led to increasing workloads for all grades of medical staff
internationally. The quality of hospital care is influenced by the number of medical staff available.
Studies indicate that hospitals with lower than expected mortality rates had on average 24%
more nurses, as well as 44% more doctors, per bed than those with the highest rates. Policies
are required to achieve proper staffing levels to enhance patient outcomes.11
Doctors are responsible for covering all the medical wards, surgical patients requiring medical
care, high dependency units and acute medical assessment units. This load is high especially
during the night. It can be difficult to predict how many of these patients will require urgent
11 Merrifield, N. (2015). Higher ratio of nurses per hospital bed linked to fewer patient deaths (available at: https://
www.nursingtimes.net/news/hospital/higher-ratio-of-nurses-per-hospital-bed-linked-to-fewer-patient-
deaths-18-12-2015/)
Sean P. Clarke, Nancy E. Donaldson. (2008). Nurse Staffing and Patient Care Quality and Safety. Patient Safety and
Quality: An Evidence-Based Handbook for Nurses: Vol. 2.

treatment during the night, so it is essential to provide enough doctors to cover both planned
and unplanned care.
Lower number of doctors per bed may make it difficult to treat the complex medical conditions
and the imbalance may negatively affect patient outcomes.
Staff nurses form an important component of any hospital. They are responsible for direct
patient care as well as execute special technical duties in areas like operation theatres, intensive
care units and highly dependent units. Thus, this indicator is useful to measure compliance
with regard to the positioned staff nurses. However, it is important to note that this indicator
excludes the Auxiliary Nurse Midwives (ANM).
Studies have shown that an appropriate size of nurse staff helps to achieve clinical and economic
improvements in patient care, including enhanced patient satisfaction, reduction in medication
errors, incidences of fall, pressure ulcers, health care-associated infections, patient mortality,
hospital readmission and duration of stay, patient care cost, nurses’ fatigue, and burnout.
Paramedics provide an immediate assessment of life threats and initiate care to stabilize the
patient prior to and during transportation to the hospital emergency department. They primarily
work as part of the emergency medical services, most often in ambulances. This indicator is
useful to assess how proactive a given hospital is with regard to emergency care since a greater
number of paramedical staff contribute to reducing response time for any medical emergency
and can, therefore, result in improved outcomes, decreased morbidity and mortality, and better
quality of care for patients.
Almost all the diagnostic procedures are carried out by the paramedical staff and they have
emerged a vital cog in the wheel of the health care delivery system.

Overall, 189 of 707 district hospitals were found to meet the doctor to bed ratio as per IPHS norms
(based on positioned doctors / IPHS norm as per bed category ≥ 1). Only 88 hospitals, however,
were found to have the ratio of staff nurses as per the IPHS norms based on corresponding bed
category. A total of 399 hospitals were found to have ratio of paramedical staff in position as
per the IPHS norms. Table 6 summarizes State/UT-wise number of district hospitals that have
positioned medical and paramedical staff in line with the IPHS norms.
Table 6: Count and percentage of district hospitals in each State/UT

meeting IPHS norms for medical and paramedical staff
District hospitals that District hospitals that

District hospitals that
met IPHS norms for met IPHS norms for
met IPHS norms for
Total positioned positioned paramedical
positioned doctors
number staff nurses staff
State/UT of district
of hospitals
of hospitals
of hospitals
Percentage
Percentage
Percentage
hospitals
hospitals
hospitals
hospitals
assessed
Total
Total
Total
Andaman and
3 0 0.00 0 0.00 2 66.67
Nicobar Islands
Andhra Pradesh 14 7 50.00 3 21.43 8 57.14


met IPHS norms for
positioned doctors
of hospitals
of hospitals
of hospitals
Percentage
Percentage
Percentage
hospitals
hospitals
hospitals
hospitals
assessed
Total
Total
Total
Arunachal
6 2 33.33 0 0.00 5 83.33
Pradesh
Assam 25 3 12.00 0 0.00 13 52.00
Bihar 36 3 8.33 6 16.67 19 52.78
Chandigarh 1 1 100.00 1 100.00 1 100.00
Chhattisgarh 19 3 15.79 1 5.26 11 57.89
Dadra and Nagar
1 1 100.00 0 0.00 1 100.00
Haveli
Daman & Diu 2 0 0.00 0 0.00 0 0.00
Delhi 18 16 88.89 11 61.11 16 88.89
Goa 2 2 100.00 2 100.00 1 50.00
Gujarat 21 1 4.76 1 4.76 3 14.29
Haryana 18 16 88.89 7 38.89 11 61.11
Himachal
11 1 9.09 0 0.00 5 45.45
Pradesh
Jammu and
19 11 57.89 0 0.00 16 84.21
Kashmir
Jharkhand 23 1 4.35 1 4.35 14 60.87
Karnataka 40 18 45.00 9 22.50 9 22.50
Kerala 21 6 28.57 1 4.76 7 33.33
Ladakh 2 1 50.00 0 0.00 2 100.00
Lakshadweep 1 0 0.00 0 0.00 0 0.00
Madhya Pradesh 51 8 15.69 13 25.49 35 68.63
Maharashtra 25 11 44.00 7 28.00 15 60.00
Manipur 7 3 42.86 1 14.29 7 100.00
Meghalaya 9 1 11.11 1 11.11 2 22.22
Mizoram 8 1 12.50 1 12.50 8 100.00
Nagaland 3 1 33.33 0 0.00 3 100.00
Odisha 32 8 25.00 1 3.13 19 59.38
Puducherry 4 2 50.00 1 25.00 4 100.00
Punjab 22 10 45.45 2 9.09 18 81.82
Rajasthan 27 10 37.04 2 7.41 19 70.37
Sikkim 4 1 25.00 0 0.00 4 100.00


met IPHS norms for
positioned doctors
of hospitals
of hospitals
of hospitals
Percentage
Percentage
Percentage
hospitals
hospitals
hospitals
hospitals
assessed
Total
Total
Total
Tamil Nadu 32 6 18.75 0 0.00 14 43.75
Telangana 6 0 0.00 0 0.00 4 66.67
Tripura 6 0 0.00 2 33.33 6 100.00
Uttar Pradesh 150 24 16.00 10 6.67 83 55.33
Uttarakhand 18 0 0.00 0 0.00 7 38.89
West Bengal 20 10 50.00 4 20.00 7 35.00
Total 707 189 26.73 88 12.45 399 56.44
Source: Primary data collected by NABH for the district hospital performance assessment
Uttar Pradesh had the highest proportion (12.7%) of doctors in position at district hospitals
meeting IPHS norms, followed by Karnataka (9.5%), Delhi (8.5%), Haryana (8.5%), and Jammu
and Kashmir (5.8%). However, looking at the percentage of hospitals in each State/UT that meet
the IPHS norm, only Chandigarh, Dadra and Nagar Haveli, and Goa had all district hospitals
fulfilling IPHS norms for positioned doctors. Figure 3.2.1 depicts the percentage of district
hospitals in each State/UT that meet the IPHS norm for positioned doctors.
Ladakh
Jammu and Kashmir
Himachal Pradesh
PunjabChandigarh
Uttarakhand
Haryana
Sikkim

Assam
Nagaland
Bihar
Meghalaya
Manipur
Jharkhand Tripura
West Bengal Mizoram
Madhya Pradesh
Gujarat
Chhattishgarh
Odisha
Maharashtra
Telengana
Andhra Pradesh
Goa
Karnataka
Andaman & Nicobar
TamilnaduPuducherry
Legend
Kerala
% of DHs that meet IPHS norm for doctors
Lakshadweep
0.0 - 4.8
4.8 - 18.7
18.7 - 37.0
37.0 - 57.8
0 87.5 175 350 525 700 57.8 - 100.0

Miles
Figure 3.2.1: Percentage of district hospitals in each State/UT that meet the doctors to
bed ratio as per IPHS norm

In the case of positioned staff nurses, a total 88 hospitals were found to have ratio of nurses
in position as per IPHS norms (based on positioned nurses / IPHS norm as per bed category
≥ 1). Madhya Pradesh had the highest proportion (14.8%) such hospitals, followed by Delhi
(12.5%), and Uttar Pradesh (11.4%). All district hospitals in Chandigarh and Goa met the IPHS
requirement.
In the case of positioned paramedical staff, a larger number of hospitals have met IPHS
requirements (Table 6).
Table 7 highlights the top hospitals in each category that have the highest ratio of medical and
paramedical staff with respect to the IPHS requirement. The top performing district hospital in
each State/UT for this KPI is listed in Annexure 4.
Table 7: Top performing district hospitals in the country for the KPI “Ratio
of doctors, nurses and paramedical staff in position to IPHS norms”

Top performing district hospitals in the country for the KPI
“Ratio of doctors in position to IPHS norms”
National average: 0.86 times the requisite staff
Range: 0.10–4.79
Lal Bahadur Shastri Hospital, DH JPC Hospital, North East, King George Hospital TH,
East, Delhi Delhi Vishakapatnam, Andhra Pradesh
DH has 4.79 times the requisite staff DH has 2.34 times the requisite DH has 4.71 times the requisite staff
staff
Babu Jagjeevan Ram Memorial Balangir, Odisha Victoria Hospital, Bangalore

Hospital Jahgirpuri, North, Delhi Urban, Karnataka
DH has 2.26 times the requisite
DH has 4.52 times the requisite staff staff DH has 4.19 times the requisite staff
Hedgewar Hospital, Shahdara, Baripada, Mayurbhanj, Odisha Hubli KIMS District Hospital,
Delhi Dharwad, Karnataka
DH has 3.76 times the requisite staff staff DH has 4.18 times the requisite staff

“Ratio of staff nurses in position to IPHS norms”
Range: 0.04–2.88
Babu Jagjeevan Ram Memorial Sanjay Gandhi Memorial Deendayal Upadhyay Hospital,
Hospital Jahgirpuri, North, Delhi Hospital Mangolpuri, North West, Delhi
West, Delhi
DH has 2.51 times the requisite staff DH has 2.88 times the requisite staff
staff
Guru Govind Singh Govt Aizawl Civil Hospital, Aizawl King George Hospital TH,
Hospital, West, Delhi West, Mizoram Vishakapatnam, Andhra Pradesh
DH has 2.36 times the requisite staff DH has 1.32 times the requisite DH has 2.05 times the requisite staff
staff

Rao Tula Ram Hospital, South Civil Hospital, Panchkula, GH Ernakulam, Ernakulam,
West, Delhi Haryana Kerala
DH has 2.11 times the requisite staff DH has 1.14 times the requisite staff DH has 1.75 times the requisite staff

“Ratio of paramedical staff in position to IPHS norms”
Range: 0.03–10.71
Civil Hospital, Rohtak, Haryana King George Hospital TH,

Aizawl Civil Hospital, Aizawl Visakhapatnam, Andhra Pradesh
DH has 8.52 times the requisite staff
West, Mizoram
DH has 10.71 times the requisite staff
Churachandpur District Hospital, staff Deendayal Upadhyay Hospital,
Churachandpur, Manipur West, Delhi
DH has 6.69 times the requisite staff North Goa District Hospital, DH has 8.32 times the requisite staff
North Goa, Goa
Combined District Hospital, Shimoga District Hospital,
Kannauj, Uttar Pradesh Shimoga, Karnataka
staff
DH has 6.06 times the requisite staff DH has 6.54 times the requisite staff
The following graphs depict the State/UT-wise average of the ratio of doctors (Figure 3.2.2),
nurses (Figure 3.2.3), and paramedical staff (Figure 3.2.4) in position to the IPHS norms. An
average score of 1 or more denotes that the State/UT has met the IPHS requirement in with
respect to its hospital category (as indicated in Table 5). The green-coloured bar in these graphs
gives the national average of the ratio of medical/paramedical staff.
Ratio of doctors in position to IPHS norms:

2.50
1.40
1.42
1.39
1.38
1.24
1.18
1.16
1.17
0.99
0.98
0.94
0.95
0.94
0.93
0.93
0.88
0.86
0.86
0.79
0.79
0.78
0.81
0.75
0.75
0.72
0.69
0.66
0.67
Meets
0.64
0.63
0.63
0.62
0.56
1
0.61
0.53
0.48
0.48
requirement
Odisha
Haryana
Goa
India
Meghalaya
Telangana
Tamil Nadu
Madhya Pradesh
Nagaland
Daman & Diu

Manipur
West Bengal
Arunachal Pradesh
Karnataka
Ladakh
Chhattisgarh
Gujarat
A & N Islands
Delhi
Andhra Pradesh
Assam
Lakshadweep
Bihar
Jammu & Kashmir
Maharashtra
Uttar Pradesh
Kerala
Mizoram
Rajasthan
Punjab
Puducherry
Jharkhand
Uttarakhand
Sikkim
Himachal Pradesh
Chandigarh
Tripura
Figure 3.2.2: State/UT-wise average ratio of doctors across hospitals in position to the
IPHS norms

1
1
Dadra & Nagar Haveli 4.26 Delhi 1.41
Ladakh 3.81 Chandigarh 1.11
Manipur 3.20 Goa 1.07
Delhi 3.14 Puducherry 0.95
Puducherry 2.90 Maharashtra 0.91
Goa 2.63
Madhya Pradesh 0.88
Mizoram 2.59
West Bengal 0.85
Haryana 2.56
Tripura 2.49
Dadra & Nagar Haveli 0.85
Arunachal Pradesh 2.44 Haryana 0.84
Andhra Pradesh 2.33 Tripura 0.79
Nagaland 2.31 Andhra Pradesh 0.77
Punjab 2.24 Punjab 0.75
Sikkim 1.92 Meghalaya 0.73
Maharashtra 1.91 Rajasthan 0.69
Madhya Pradesh 1.81
Manipur 0.68
Chandigarh 1.78
Karnataka 0.62
A & N Islands 1.68
Jammu & Kashmir 1.59 India 0.60
Rajasthan 1.55 Chhattisgarh 0.60
India 1.54 Kerala 0.59
Uttar Pradesh 1.43 Assam 0.57
Odisha 1.38 Bihar 0.57
IPHS norms
Assam 1.37 Ladakh 0.56
to the IPHS norms

Telangana 1.36 Mizoram 0.56
Chhattisgarh 1.33
Ratio of staff nurses in proportion to IPHS norms:
Daman & Diu 0.54

Kerala 1.30
Telangana 0.54
Bihar 1.19
Jharkhand 1.17 Gujarat 0.54
Ratio of paramedical staff in proportion to IPHS norms:

Himachal Pradesh 1.11 Arunachal Pradesh 0.53
West Bengal 1.05 Odisha 0.50
Tamil Nadu 1.03 A & N Islands 0.50
Karnataka 1.00 Tamil Nadu 0.48
Lakshadweep 0.97 Lakshadweep 0.47
Uttarakhand 0.83
Sikkim 0.47
Meghalaya 0.71
Nagaland 0.47
Gujarat 0.64
Uttar Pradesh 0.43
IPHS norm for each of the 5 bed strength categories can be found in Annexure 5.
Daman & Diu 0.40
Uttarakhand 0.35
Himachal Pradesh 0.32
Figure 3.2.3: State/UT-wise average ratio of nurses across hospitals in position to the
Meets
Figure 3.2.4: State/UT-wise average ratio of paramedical staff across hospitals in position
Jammu & Kashmir 0.32
Jharkhand 0.27
requirement
Meets requirement

The State/UT-wise average ratio of doctors, nurses, and paramedical staff in position to their
31

Victoria Hospital, Bangalore, due to its affiliation with Bangalore Medical College and Research
Institute (BMCRI), has a higher workforce of doctors. In the past years, construction of new
buildings, improvement of existing infrastructure, procurement of new modern equipment and
appointment of faculty on contract basis has played important roles in hospital’s performance
in this indicator.
Hubli KIMS District Hospital located in Dharwad district, Karnataka is well above the IPHS
recommended number of positioned doctors. The administration ensures timely recruitment
of faculty as per the sanctioned posts, awards promotions to doctors in higher cadres, and
creates new posts as per requirement. Further, through a compulsory one-year senior residency
program, Senior Residents after their MD/MS are posted regularly.
In Churachandpur District Hospital, Manipur and Shimoga District Hospital, Karnataka, prompt
monitoring, regular data collection and reporting to the Directorate has resulted in continuous
evaluation, thereby improving performance. Decentralized recruitment of paramedical staff in
a phased manner with preference to local candidates was practiced in Civil Hospitals in the
districts Rohtak and Panchkula of Haryana. They also conducted mass recruitment drives for
the posts of ANMs and staff nurses as part of a single exercise. Providing an enabling work
environment improved employee satisfaction and decreased attrition rate.
In General Hospital Ernakulam, Kerala, human resource support is provided from National
Health Mission and temporary postings through the Hospital Development Society. North Goa
District Hospital and Combined District Hospital, Kannauj, Uttar Pradesh also undertake similar
measures to ensure staff availability to meet the service demand.
King George Hospital, a tertiary care facility in Visakhapatnam, Andhra Pradesh utilizes the
patient footfall and bed strength in addition to the Medical Council of India norms as a tool to
determine and fill the required number of posts for various specialties.
“The ratio of doctors against its IPHS requirement in the district hospitals in Balangir
and Mayurbhanj is higher than most other district hospitals in the country. Here, the
district administration, in close co-ordination with the Government and the co-located
Medical College & Hospital, has provided sufficient doctors for providing Clinical/
Medical Services to the patients. Further, few super-specialisation departments were
also functionalized like Urology, Cardiology, etc. engaging contractual doctors from
corpus funds to provide super-specialization services to the patients.”
—Joint Secretary to Government, Health & Family Welfare Department,
Government of Odisha
The Aizawl Civil Hospital in Mizoram utilizes the Rogi Kalyan Samiti (RKS) and National Health
Mission (NHM) fund for the recruitment of nurses and paramedical staff. Owing to low availability
of health care staff, the hospital specifically recruited and trained technicians who could provide
services on non-working days. This has improved their performance, both in quality and quantity.
Sanjay Gandhi Memorial Hospital, Mongolpuri in Delhi North West and Lal Bahadur Shastri
Hospital in Delhi East ensure that there are frequent recruitments and that vacancies are filled
at regular intervals. Babu Jagjeevan Ram Memorial Hospital Jahgirpuri, Delhi North ensures
retention of staff through regular training and periodic monitoring.

“The requirement for sufficient nursing staff was conveyed from time to time to the
higher authorities, who have vindicated the same. In spite of being located in a far-
flung area, the nursing staff have shown enthusiasm to work in this hospital, owing
to its work ethic and environment.”
—Medical Superintendent, Rao Tula Ram Memorial Hospital, Delhi South West
The staff in Deendayal Upadhyay Hospital, Delhi West is optimally distributed in all wards
to cater to the patient load. Regular monitoring of ward-wise allocations helps in quick
identification of shortfall and necessary action. JPC Hospital in Delhi North East caters to
a population of approximately 15 lakhs. The average OPD attendance is around 3000 and
daily casualty attendance is approximately 800 patients. The requirement of staff is reviewed
periodically, and their services are being utilized effectively as per the patient load of the
hospital. Hedgewar Hospital, Shahdara, Delhi has implemented a residency scheme, having in
place 51 Senior Resident doctors and 40 Junior Resident doctors. The increase in the number
of doctors is still necessary given the patient load, especially in the departments of Obstetrics
and Gynaecology and Accident and Emergency. In Guru Govind Singh Government Hospital,
Delhi West, the bed strength was increased to cater to the patient load, following which the
State sanctioned additional staff for the new services.
Recommendations to States/UTs
A periodic review of the vacancies must be conducted in all district hospitals in
order to ensure timely recruitment of doctors, nurses, and paramedical staff, thereby
contributing to better health outcomes.
States may utilize flexibilities under NHM to engage HR and assume availability of
full contingent of HR as per IPHS norms.
Nurses and paramedical staff should be well trained, and have periodic refresher
training sessions.
Bi-annual trainings for nurses and paramedical staff may be conducted at the nearest
medical college.

3.3 AVAILABILITY OF SUPPORT SERVICES

Support services assist doctors and nurses in carrying out their responsibilities. Given that their
work is broad-based and their responsibilities are crucial in the working of a district hospital, it
is important to measure the coverage of support services while holistically assessing hospital
performance. The KPI includes the proportion of support services available in a hospital out of
the following identified 14 sevices:
i. HIS implemented in OPD
ii. HIS implemented in IPD
iii. HIS implemented in pharmacy
iv. HIS implemented–complete HIS
v. Sterilization and Disinfection
vi. Fully equipped blood bank
vii. Waste management including biomedical waste
viii. Medico-legal/postmortem Service
ix. Hospital Transport Ambulance (Basic Life Support/ Advanced Life Support)
x. Dietary services for patient
xi. Electric supply (power generation and stabilization)
xii. Drugs and pharmacy
xiii. Water supply
xiv. Refrigeration
It is calculated by dividing the number of support services available in the hospital by the total
number of support services. This KPI lies in the domain of Structure. The district hospital has
control over the indicator.
Total number of support services available

Availability of support services =
14

Hospital support services, though not directly involved with patient care, complement the
clinical services and contribute to enhancing the reliability, hygiene, safety, and comfort of health
care environments, ultimately leading to wider and better health outcomes. Without them, the
day-to-day clinical services in a hospital would be adversely impacted. They have a crucial role
in the mitigation of clinical conditions and delivery of safe care to the patients. The overall
patient satisfaction greatly depends on the quality of hospital supportive services rendered to

him during his stay. These services usually work at the back end but their contribution in the
overall care of a patient is nowhere less than that of the clinical services. Therefore, identifying
the need for a balanced health workforce with capacity and regular skill training to provide
support services becomes important from the aspect of public health planning.12

A total of 89 hospitals fulfilled the criteria of having all support services available (based on
available services/ total services score=1) belonging to States/UTs shown in Figure 3.3.1. Tamil
Nadu had the highest proportion (20.2%) of hospitals with all support services, followed by
Rajasthan (11.2%), Uttar Pradesh (10.1%), Karnataka (10.1%), and West Bengal (9%).
18
10
9 9
8
7
4 4
3 3
2 2 2 2
1 1 1 1 1 1
Figure 3.3.1: State/UT-wise distribution of the number of hospitals (n=89) with availability
of all support services
On an average, every district hospital in India has 11 support services. The State/UT-wise average
number of support services in a district hospital is depicted in Figure 3.3.2. Annexure 5 includes
the hospital category-wise graphs depicting the average number of services in each State/UT.
12 Siganporia, P., Astrakianakis, G., Alamgir, H., Ostry, A., Nicol, A. M., & Koehoorn, M. (2016). Hospital support services
and the impacts of outsourcing on occupational health and safety. Int J Occup Environ Health, 22(4), 274-282. doi:
10.1080/10773525.2016.1227035
Figueroa, R. L., & Vallejos, G. E. (2013). Supporting management of medical equipment for inpatient service in public
hospitals: a case study. Annu Int Conf IEEE Eng Med Biol Soc, 2013, 898-901. doi: 10.1109/EMBC.2013.6609646
Singh, D., Qadri, G., Kotwal, M., Syed, A., & Jan, F. (2009). Quality control in linen and laundry service at a tertiary
care teaching hospital in India. Int J Health Sci (Qassim), 3(1), 33-44.
Ukleja, A., Gilbert, K., Mogensen, K. M., Walker, R., Ward, C. T., Ybarra, J., . . . Enteral Nutrition. (2018). Standards for
Nutrition Support: Adult Hospitalized Patients. Nutr Clin Pract, 33(6), 906-920. doi: 10.1002/ncp.10204
WHO, “Regional Action Framework on Improving Hospital Planning and Management in the Western Pacific”
https://iris.wpro.who.int/bitstream/handle/10665.1/14248/WPR-RC069-09-Hospital-Ann-2018-en.pdf

14 14 Availability of all identified services

13 13 13 13
14 13 13 12 12
12 12 12 12 11
11 11 11 11 11
10 10 10 10 10 10
10 10 10 9 9 9
9 9 9 8
4
3
Odisha
Nagaland
Arunachal Pradesh
Telangana
Goa
India
Meghalaya
Ladakh
A & N Islands
Daman & Diu
Tamil Nadu
Madhya Pradesh
Karnataka
Bihar
Uttar Pradesh
Gujarat
Delhi
Maharashtra
Kerala
Mizoram
Manipur
Uttarakhand
Rajasthan
West Bengal
Tripura
Puducherry
Jharkhand
Jammu & Kashmir
Sikkim
Punjab
Assam
Lakshadweep
Chandigarh
Andhra Pradesh
Haryana
Chhattisgarh
Himachal Pradesh
Figure 3.3.2: Average number of support services in a district hospital by State/UT
Table 8 lists the top performing district hospitals in the country that have all support services.13
The top performing district hospital in each State/UT for this KPI is listed in Annexure 4.
Table 8: Top performing district hospitals in the country that have all the
identified support services (N=14)
Small hospital Mid-sized hospital Large hospital
Baramula, Jammu and Kashmir Aizawl Civil Hospital, Aizawl Shimoga District Hospital,
West, Mizoram Shimoga, Karnataka
Usilampatti, Madurai, North Goa District Hospital, GH Ernakulam, Ernakulam,

Tamil Nadu North Goa, Goa Kerala
Civil Hospital, Hisar, Haryana Civil Hospital, Panchkula, Dindigul District Hospital,
Haryana Dindigul, Tamil Nadu
National average: 11
Range: 3–14

The Aizawl Civil Hospital in Mizoram makes use of the RKS fund for procuring of required
consumables and equipment (e.g., fully automatic analyzer) to provide efficient support services.
The hospital took lead in engaging a qualified firm for the annual or comprehensive maintenance
contract (AMC/CMC) of the hospital equipment. Regular skill training of the staff has played a
pivotal role in increasing efficiency of the hospital.
District Hospital Baramulla, Jammu and Kashmir has taken multiple initiatives to improve
their availability of support services. These included outsourcing various support services like
13 As 89 hospitals were found to have all support services, top three hospitals having the highest composite score
(average of the scaled values of all 10 KPIs) within each hospital category among these 89 hospitals were shortlisted.
A list of the 89 district hospitals that have all requisite support services can be found in Annexure 6.

housekeeping, laundry, diet, security, bio medical waste disposal etc., using the mandate for
implementation of Kayakalp initiative. In order to ensure infection control and prevent the
reuse of linen, the hospital has implemented colour coding of bed sheets on specified days.
The e-Aushadhi software facilitates smooth coordination with the pharmacy’s supply chain
management. IEC has been effectively used for proper disposal and segregation of bio-medical
waste. The provision of working and calibrated biomedical instruments in addition to providing
diagnostics in a public–private partnership mode has led to availability of maximum possible
tests in a cost-efficient way. Specific monitoring mechanisms have also been put in place for
proper implementation of all these services.
In Haryana, the Civil Hospitals in Hisar and Panchkula have outsourced these support services
to private service providers selected through tenders. This has greatly resulted in mitigation of
infection and delivery of care to patients, especially during the COVID-19 pandemic.
“We have co-ordinated all available funds, including government

funds, NHM funds, MP-MLA funds, CSR funds, and Hospital
Development Society (HDS) Funds in providing all 14 support
services to the sick and needy. Sponsor meetings were arranged
for accumulating CSR funds and the proposals were reviewed and
approved by the HDS for further implementation.”
—Deputy Director of Health Service,

General Hospital Ernakulam, Kerala
Across the country, similar interventions are undertaken in North Goa District Hospital, Goa;
Shimoga District Hospital, Karnataka; Dindigul and Usilampatti District Hospitals, Tamil Nadu.
Regular monitoring of the services and prompt appointment of specialists, trained nurses, and
paramedical staff. NQAS served as a reference point for implementing and sustaining quality
standards.
Recommendations for district hospitals

Wherever medical colleges are located near a district hospital and have additional
or excess capacity in terms of support services, cross utilisation may be encouraged.
Each of these services has had a significant role to help abort the ‘chain of transmission’
of COVID-19 infection across various patient care areas in the hospital, while providing
them supportive services.14
Central and State funds may be utilized in the procurement of services.
14 Sodhi, J., Satpathy, S., & Arora, P. (2020). Role of hospital supportive services in COVID-19. International Journal of Infection
Control, 16(3). doi: 10.3396/ijic.v16i3.20499

3.4 AVAILABILITY OF CORE HEALTH CARE SERVICES

This KPI belongs to the domain of Structure and comes under the control of the State. This
indicator includes the core medical competencies of any given district hospital. Its inclusion
incorporates the breadth of health care services provided.
It is the proportion of 14 recommended specialties from the following list that are functional
against the total number of specialties required:
i. General Medicine
ii. General Surgery
iii. Obstetric & Gynaecology
iv. Paediatrics including Neonatology (as required for level II SNCU)
v. Emergency (accident & other emergency) (Casualty 24X7 basis)
vi. Critical Care (ICU)
vii. Anaesthesia
viii. Ophthalmology
ix. ENT
x. Dermatology and Venereology (Skin & VD) RTI / STI
xi. Orthopedics
xii. Dental care
xiii. Public Health Management
xiv. Radiology
It is calculated by dividing the number of core health care services available in the hospital by
the total number of core health care services the hospital is expected to maintain. This KPI lies
in the domain of Structure. The State has control over the indicator.
Total number of core

health care services available
Availability of core health care services =
14

Each health care specialty at a hospital has its own role and significance in delivering patient
care. The critical care services focus on resuscitating unstable patients and allowing time for
recovery or the effect of specific therapies to improve outcomes and prevent death. The hospital
care department is mostly dependent upon the emergency services for providing medical
and surgical provisions for the patients in need of immediate care and attention. Emergency
Care in fact serves as the first point of contact for many patients. Especially when there are

logistical or financial barriers to health care access, people may present for care only when
they are symptomatic with acute illness or injury. As the number of patients visiting ER has
been increasing from day to day, the reliance on ER care is now more comprehensive than ever.
This dependence is mostly because it remains open all round the clock and can never deny
admission to a patient.15
A hospital providing all specialties gives the patient an opportunity to receive a wider range
of expert inputs under one roof, all of which combine to create a course of treatment that will
offer the best outcome.16

A total 101 out of 707 hospitals fulfilled the criteria of having all 14 functional specialties belonging
to States/UTs shown in Figure 3.4.1. Tamil Nadu had the highest proportion (16.8%; 17/101) of
hospitals with all functional specialties, followed by Karnataka (13.9%; 14/101), West Bengal (10.9;
11/101%), and Kerala (9.9%; 10/101).
17
14
11
10
9
8
5 5 5
4
3
2
1 1 1 1 1 1 1 1
Figure 3.4.1: State/UT-wise distribution of number of hospitals (n=101) with all 14 functional
core health care services
15 Schell, C. O., Gerdin Warnberg, M., Hvarfner, A., Hoog, A., Baker, U., Castegren, M., & Baker, T. (2018). The global need
for essential emergency and critical care. Crit Care, 22(1), 284. doi: 10.1186/s13054-018-2219-2
16 Morley, C., Unwin, M., Peterson, G. M., Stankovich, J., & Kinsman, L. (2018). Emergency department crowding:
A systematic review of causes, consequences and solutions. PLoS One, 13(8), e0203316. doi: 10.1371/journal.
pone.0203316

14 14 14 Availability of all identified services

13 13 13 13 13
14 13 13 12
12 12 12 12
11 11 11 11 11
11 10 10 10 10 10 10
10 10 10
9 9 9 8
8 7
5
3
Odisha
Nagaland
Goa
Telangana
Tamil Nadu
Ladakh
Karnataka
Delhi
Madhya Pradesh
Meghalaya
Arunachal Pradesh
Kerala
Bihar
India
A & N Islands
West Bengal
Maharashtra
Gujarat
Daman & Diu
Uttar Pradesh
Rajasthan
Himachal Pradesh
Punjab
Puducherry
Mizoram
Manipur
Uttarakhand
Chandigarh
Jammu & Kashmir
Assam
Tripura
Jharkhand
Sikkim
Lakshadweep
Andhra Pradesh
Haryana
Chhattisgarh
Figure 3.4.2: State/UT-wise average number of available core health care services in a
district hospital
Table 9 lists the top performing district hospitals in the country that have all core health
care services.17 The top performing district hospital in each State/UT for this KPI is listed in
Annexure 4.
Table 9: Top performing district hospitals in the country that have all the
identified core health care services (N=14)
Small Hospital Mid-Sized Hospital Large Hospital

Kulithalai, Karur, Aizawl Civil Hospital, Shimoga District Hospital,
Tamil Nadu Aizawl West, Mizoram Shimoga, Karnataka
Government General Hospital, Balangir, Odisha Hubli KIMS District Hospital,
Mahe, Puducherry Dharwad, Karnataka
DH Tirur, Malappuram, Kerala Sanjay Gandhi Memorial GH Ernakulam, Ernakulam,
Hospital Mangolpuri, Kerala
North West, Delhi
National average: 10 Range: 1–14

Aizawl Civil Hospital utilized the facility’s RKS fund for infrastructure development and
engagement of additional manpower which widely augmented the availability of proper intensive
care unit (ICU), newborn intensive care unit (NICU), geriatric care unit, dental services among
others. These initiatives have resulted in higher footfall, efficient use and reduced referrals from
the hospital.
17 As 101 hospitals were found to have all core health care services, top three hospitals having the highest composite score (average
of the scaled values of all 10 KPIs) within each hospital category among these 101 hospitals were shortlisted. A list of these 101
hospitals can be found in Annexure 6.

Balangir District Hospital in Odisha provides various specialized and non-specialized clinical
OPD services along with 24×7 causality and emergency services. The hospital is diligently
providing the 14 identified core healthcare services. The IPD services are also very well manned
with trained staff nurses present round the clock along with the patients. The ancillary services
of the hospital are also very good like the hospital provides mechanized housekeeping services,
smart security services with CCTV cameras, mechanized laundry services, help desk services
(May I Help You), free diet services, proper waste management services, central registration
services, free drug services, free investigation services, free high-end diagnostic services like CT
scan, dialysis, etc. Interventions undertaken by Government General Hospital Mahe, Puducherry
are of a similar nature.
In DH Tirur in Mallapuram district of Kerala the main initiative was infrastructure development,
especially in the women and child hospital wings. With a dedicated team, skilled doctors and
supporting staff and support from local self-government, that is, the District Panchayat, they
were able to secure financial support from the LSGD, MLA and MP. More importantly, the core
health care services were also catered to through support from NRHM.
General Hospital Ernakulam, Kerala and Shimoga District Hospital, Karnataka conduct regular
monitoring and review to ensure availability of services at all times. Hubli KIMS District Hospital
in Dharwad, Karnataka has constituted a quality circle team for each department with regular
internal assessment of the various service provisions as per the guidelines of LaQshya and
NQAS. They execute targeted and time-bound action plans for the gaps in various service
provisions.
Given that Sanjay Gandhi Memorial Hospital in Mangolpuri, North West Delhi caters to a
large population of 25 lakh and has a huge inflow of patients, there is a constant need to
ensure the availability and functionality of these services. These are ensured by improving
infrastructure, manpower, and machinery at the regular intervals. Quality initiatives were taken
up to ensure optimal delivery of services. Obtaining NQAS certification also ensured maintaining
the functionality of all available services and monitoring of same at regular intervals — the same
was observed in DH Kulithalai in Karur, Tamil Nadu.
Recommendations for States/UTs

District hospitals may be linked to the nearest medical college by employing a hub
and spoke distribution model, which is a cost-effective and time-saving transport
and service distribution mechanism.18
Periodic review and reporting on the quality of services is a good practice to identify
the gaps and take necessary actions.
Service delivery of the essential components under this indicator may be improved
by adhering to the guidelines put forth by NQAS.
18 Elrod, J.K., Fortenberry, J.L. The hub-and-spoke organization design: an avenue for serving patients well. BMC
Health Serv Res 17, 457 (2017). https://doi.org/10.1186/s12913-017-2341-x

3.5 AVAILABILITY OF DIAGNOSTIC TESTING SERVICES

Diagnostic testing is generally performed to screen for, monitor, and detect diseases. Early
detection and proper treatment depend on establishing a correct diagnosis. This is often aided
by laboratory, radiology, and imaging services. Their inclusion in performance assessment is
particularly important given that they have the potential to change the pre-test probability of
disease into a post-test certainty that is more definitive, hence providing a better information
set of the patient to the doctor. However, this indicator excludes testing done via referral
laboratories. For this KPI, the following 14 diagnostic testing services were identified:
i. Urine Analysis
ii. Stool Analysis
iii. PAP smear
iv. Sputum
v. Haematology
vi. Microbiology
vii. Serology
viii. Biochemistry
ix. Cardiac Investigations
x. Ophthalmology
xi. ENT
xii. Radiology
xiii. Endoscopy
xiv. Physiology (Pulmonary function test)
It is calculated by dividing the number of diagnostic testing services available in the hospital
by the total number of diagnostic testing services the hospital is expected to maintain (i.e. all
14 services). This KPI also lies in the domain of Structure. The State exercises control over it
rather than the district hospital.
Total number of diagnostic

testing services available
Availability of diagnostic testing services =
14

About 60–70 per cent of medical treatments are based on laboratory diagnostic tests, thus
making it one of the most indispensable segments in the health care industry. Diagnostics may
not completely aid in curing the disease but can go a long way in this direction.

District hospitals are secondary level health care providers in India with basic specialties, though
IPHS has laid down norms with respect to the number of specialties, types of treatments, and
requirement for diagnostic services, most States/UTs in India are not able to adhere to the same
for want of one or more factors. It is observed that in most public hospital laboratories the
diagnostic centres are not adequately equipped with equipment, technology, and manpower.
These lacunae in the system19 adversely affect the efficiency and operation of the hospital by:
Delaying the treatment procedure and inhibiting the continuity of the treatment
Restricting the treatment capacity of the medical practitioners
Allowing for judgmental errors on the condition of the patients due to absence of
proper diagnostics
Lack of appropriate diagnostic testing service may adversely affect the treatment
outcomes
This also demotivates the medical practitioners as they are not able to extend their services
to their fullest capacity.
The importance of the diagnostic testing services at public health facilities like district hospital
is to ensure availability and access so as to reduce out of pocket expenditure incurred by
patients on diagnostics.

Only 21 hospitals belonging to States/UTs shown in Figure 3.5.1 fulfilled the criteria of having
all diagnostic testing services available (based on available services/ total services score=1).
Karnataka had the highest proportion (28.6%) of hospitals with all support services, followed
by Telangana (19%), Andhra Pradesh (14%), and Gujarat (9.5%).
4
3
2
1 1 1 1 1 1
Figure 3.5.1: State/UT-wise distribution of number of district hospitals (n=21) with all 14
functional diagnostic testing services available
19 ICRA Management Consulting Services Ltd, “Prefeasibility Report for Setting up of Diagnostic Centre at District
Hospital Dharwad” 2013 http://abhinavinfo.com/idd_new/assets/pdf/pre_feasibility_studies/70b_DiagnosticLab_
Dharwad.pdf

14 14
13 Availability of all identified services
14 12 12 12
11 11 11 11
11 10 10 10 10
10 10 10 9 9
9 9 9 9 9
8 8 8 8 8 8 8
8 7 7
7
6 6
Dadra & Nagar…
Odisha
Telangana
Goa
India
Tamil Nadu
Nagaland
Daman & Diu
Meghalaya
Chandigarh
Gujarat
Jharkhand
Manipur
Arunachal Pradesh
A & N Islands
Andhra Pradesh
Ladakh
Karnataka
Chhattisgarh
Tripura
Bihar
Delhi
Assam
Lakshadweep
Uttar Pradesh
Mizoram
Uttarakhand
Maharashtra
Punjab
Kerala
Puducherry
Rajasthan
Sikkim
Haryana
Himachal Pradesh
West Bengal
Jammu & Kashmir

Madhya Pradesh
Figure 3.5.2: State/UT-wise average number of available diagnostic testing services in a
district hospital
Table 10 lists the top performing district hospitals in the country that have all diagnostic
testing services.20 The top performing district hospital in each State/UT for this KPI is listed in
Annexure 4.
Table 10: Top performing district hospitals in the country that have all or
most of the identified diagnostic testing services (N=14)
Tandur, Vikarabad, Aizawl Civil Hospital, Shimoga District Hospital,

Telangana Aizawl West, Mizoram Shimoga, Karnataka
Pt. Madan Mohan Malviya DH Khammam, Khammam, Hubli KIMS District Hospital,
Hospital, South, Delhi Telangana Dharwad, Karnataka
Baramula DH, Baramula, District Hospital Gadchiroli, Kilpauk Hospital, Chennai,

Jammu and Kashmir Gadchiroli, Maharashtra Tamil Nadu
National average: 9
Range: 0–14

Pandit Madan Mohan Malviya Hospital in South Delhi district, Delhi installed different equipment
such as five-part haematology analyzer, fully automatic biochemistry analyzer, CR System for
300 MA X-ray machine, etc. The procurement process for equipment was streamlined through
Government e-Marketplace (GeM). Microbiology services were strengthened through installation
of Biosafety Cabinet for managing biomedical waste (BMW) generated in the laboratory and a
BMW sterilizer was also installed. At the same time, training and re-training of staff was done
20 As 21 district hospitals were found to have all diagnostic testing services, top three hospitals having the highest composite score
(average of the scaled values of all 10 KPIs) within each hospital category among these 21 hospitals were shortlisted. A list of
these 21 hospitals can be found in Annexure 6.

regularly for ensuring optimal utilization of the equipment. This led to improvement in usage,
regular maintenance of the equipment, and reduction of down time. The turnaround time for the
investigation reduced and the hospital could efficiently manage the increasing load of patients.
New investigations like HbA1C, Serum iron, serum Amylase and serum Ca & Pot were able to
be conducted and overall patient satisfaction improved.
District Hospitals Kammam (Khamman district) and Tandur (Vikarabad district) have all the
identified diagnostic testing services. While the hospitals do take proactive measures to
ensure the availability and functionality of the required services, the recently launched T-Hubs
(Telangana Diagnostics) initiative of the Government of Telangana has been instrumental in
establishing the requisite services in every district of the state under NHM, which has also led
to a reduction in out-of-pocket expenditure for the patients.
Karnataka Infrastructure Development Department conducted a prefeasibility study for setting
up a diagnostic centre at Dharwad District Hospital.21 Such interventions throw light on the
gaps and requirements to be fulfilled and help addressing the shortfall in an optimal manner.
Hubli KIMS DH and Shimoga DH have taken such adequate measures to ensure the availability
of all services.
DH Baramulla in the UT of Jammu and Kashmir ensured availability through various measures:
implementation of Free Diagnostic Initiative with support from NHM and the pro-active role of
hospital management has ensured uninterrupted supply of test kits, reagents and consumables;
streamlining of Jammu and Kashmir Medical Services Corporation Ltd. (JKMSCL) has improved
the supply chain mechanism and timely procurement of bio-medical equipment, reagents and
consumables; for appropriate calibration and functioning of biomedical equipment, Bio-Medical
Equipment Maintenance and Management program is implemented through PPP mode.
After the empanelling of the hospital under the CMCHIS of Tamil Nadu Government and AB-PMJAY
of the Central Government, Kilpauk Hospital, Chennai was able to perform major diagnostic
procedures and the amount earned was used to improve infrastructure and consumables. Due to
State and Central Government empanelment for insurance schemes, many diagnostic services
(like dynamic MRI, CT scan, digital mammogram, RT PCR for Microbiology, new born OAE (Oto
acoustic emission screening), etc.) are performed free of cost to patients. The hospital used
to face issues primarily in training; for new investigations like RT PCR or mammogram biopsy,
the personnel were asked to undergo immediate training. Lack of availability of consumables
required to perform investigation was tackled by fund raising using the insurance scheme.
Gadchiroli District Hospital, Maharashtra has witnessed significant development. In 1994, the
hospital was a 100-bedded hospital. It had a small laboratory, inadequate equipment, reagents,
kits and vacant posts of Lab Technologists. Medical Officers/ specialists were reluctant to join
due to the inaccessibility of the district. Presently, the hospital has 286 functional beds; vacancies
for medical officers and specialists, pathologists and microbiologists, and trained technicians are
filled through NHM, NCD, IPHS, and State provisions. Laboratories have been strengthened with
procurement and supply of equipment, machines, instruments, kits, lab reagents, etc. Calibration
of instruments and equipment are done regularly to minimise laboratory errors. There are 14
laboratories and 2 mobile pathology units. The State has outsourced laboratory investigations
21 ICRA Management Consulting Services Ltd, “Prefeasibility Report for Setting up of Diagnostic Centre at District
Hospital Dharwad” 2013 http://abhinavinfo.com/idd_new/assets/pdf/pre_feasibility_studies/70b_DiagnosticLab_
Dharwad.pdf

to HLL Labs for all hospitals in the district, which allowed for free investigations and cashless
treatment of poor villagers and tribals.
Recommendations to States/UTs
Hiring dedicated paramedical staff to maintain service records and handle laboratory
equipment would help in timely identification of shortfall of services.
Often diagnostic facilities have breakdowns of necessary equipment as the staffers
are not provided necessary training and skills required to run these state-of-the-art
equipment. Regular training of staff whenever new equipment is purchased is crucial,
so that expensive diagnostic equipment is adequately taken care of.
External agencies may be roped in for Bio-Medical Equipment Maintenance and
Management in order to reduce downtime of dysfunctional equipment and ensure
regular upkeep of the hospital equipment.
Provisions under the National Health Mission and State Health Department schemes
may be utilized to procure high-end equipment such as automatic analyzers, CT
Scan machines, advanced USG machines, ELISA readers, digital X-rays, etc. and the
supporting manpower strengthening may be facilitated through the DNB program.

3.6 BED OCCUPANCY RATE

This KPI is classified under the domain of Output and falls under the control of the district
hospital. It reflects efficiency in the use of hospital beds. The bed occupancy rate is calculated
by dividing the total number of inpatient bed days added for a year by the number of functional
beds available in the hospital multiplied by 365 days. The ratio is multiplied by 100 to express
the figure in percentage. The number of inpatient bed-days refers to the sum of all inpatients at
midnight. The bed occupancy rate shows the effective utilization of available beds in a hospital.
Total number of inpatient

bed days added for a year
Bed occupancy rate = × 100
Total Functional Beds × 365

A high bed occupancy rate reflects good quality of services, infrastructure, trained staff, patient
care and satisfaction provided by the facility. From the point of view of public health planning,
the bed occupancy rate helps in identifying facilities with optimal resource utilization rate.
This further highlights the need of the facility to balance demand and supply side factors. The
indicator can be used to assess hospital performance and recognize areas for improvement.
The reasons for the respective level of utilization can be identified and future decisions can be
made based upon this. This indicator can be further used for comparison among facilities at
the state/region/national level and find their efficiency.22
Very low bed occupancy rates (<42%) at primary health care level has indicated lack of medically
trained personnel, sporadic supply of drugs and other medical supplies and a complete
breakdown in the transfer and referral system.23 High bed occupancy rate is an indicator of
health system under pressure. Hospitals cannot operate at 100% occupancy, as spare bed
capacity is needed to accommodate variations in demand.24 Lack of available beds increase
delays in emergency departments, cause patients to be placed on clinically inappropriate wards
and increase the rate of hospital-acquired infections. This also puts staff under pressure to free
up beds that can pose a risk to patient safety.25
22 World Bank (1993). Public hospitals in developing countries (available at: https://documents1.worldbank.org/
curated/en/919871468740383421/pdf/multi0page.pdf)
Aloh, H.E., Onwujekwe, O.E., Aloh, O.G., & Nweke, C.J. (2020). Is bed turnover rate a good metric for hospital
scale efficiency? A measure of resource utilization rate for hospitals in Southeast Nigeria. Cost Effectiveness and
Resource Allocation, 18(21). doi: 10.1186/s12962-020-00216-w
23 Okello, D., Guwatudde, D., Sebina, A., & Lubanga, R. (1994). Low bed occupancy rates in Uganda’s peripheral health
units: is it a policy problem? East African Medical Journal, 71(9), 601–603.
24 Madsen, F., Ladelund, S., Linneberg, A. (2014). High levels of bed occupancy associated with increased inpatient
and thirty-day hospital mortality in Denmark. Health Affairs, 33(7). doi: 10.1377/hlthaff.2013.1303
Friebel, R., Fisher, R., Deeny, S. R., Gardner, T., Molloy, A., & Steventon, A. (2019). The implications of high bed
occupancy rates on readmission rates in England: A longitudinal study. Health Policy, 123(8), 765–772. doi: 10.1016/j.
healthpol.2019.06.006
25 Rezaei, S., Hajizadeh, M., Nouri, B., Ahmadi, S., Rezaeian, S., Salimi, Y., & Karyani, A. K. (2019). Iranian hospital
efficiency: a systematic review and meta-analysis. International Journal of Health Care Quality Assurance, 32(2),
385–397. doi: 10.1108/IJHCQA-03-2018-0067

3.6.3 Juxtaposition of the KPI with recommended norms

A bed occupancy rate of 80-85% is considered ideal, at which a facility is designed to operate
most efficiently. IPHS guidelines, 2012 recommend the optimum bed occupancy in district
hospitals to be 80%.

Given that government hospitals cannot deny admission to patients, the bed occupancy rate
in many hospitals (n=123) were found to exceed 100% occupancy rate. In the framework used
in this analysis, bed occupancy rate is given a maximum limit of 90, and values above 90 are
considered as 90. Figure 3.6.1 depicts the average bed occupancy rate in a district hospital by
State/UT. The top performing district hospital in each State/UT for this KPI is listed in Annexure
4, while the average bed occupancy rate in small, mid-sized, and large hospitals by State/UT
are illustrated in Annexure 5.
90.00
90.00
83.42
80.07
83.15
Ideal bed occupancy rate

75.34
74.64
74.07
73.34
72.79
90
68.41
65.68
64.85
60.09
60.57
59.60
59.81
56.50
57.28
56.28
54.92
57.17
52.49
48.62
48.01
44.06
44.48
45.41
37.96
33.95
33.47
33.35
32.82
31.01
26.39
23.98
22.73
21.38
Sikkim
Kerala
West Bengal
Assam
Karnataka
Jammu & Kashmir
Himachal Pradesh
Andhra Pradesh
Madhya Pradesh
Meghalaya
Rajasthan
Puducherry
A & N Islands
Arunachal Pradesh
Daman & Diu
Maharashtra
Punjab
Telangana
Tamil Nadu
Lakshadweep
Mizoram
Tripura
Chhattisgarh
Gujarat
Uttar Pradesh
Nagaland
Chandigarh
Delhi
Uttarakhand
Jharkhand
Haryana
Odisha
India
Goa
Bihar
Manipur
Ladakh
Figure 3.6.1: Average bed occupancy rate (%) of a district hospital by State/UT
Of 707 hospitals, a total of 182 hospitals had bed occupancy rate of 90% or higher. Figure 3.6.2
shows the State/UT-wise percentage distribution of these 182 hospitals. Uttar Pradesh (14.8%)
had the highest proportion of hospitals with bed occupancy rate greater than or equal to 90%,
followed by Madhya Pradesh (10.9%), Maharashtra (8.2%), Odisha (8.2%), West Bengal (7.1%),
and Andhra Pradesh (5.5%).

27
20
15 15
13
10 9
8 8
6 6 6 6
4 4 4 3 3 3
2 2 2 1 1 1 1 1 1
Sikkim
Kerala
West Bengal
Karnataka
Jammu & Kashmir

Madhya Pradesh
Andhra Pradesh
Rajasthan
Assam
Himachal Pradesh
Tamil Nadu
Meghalaya
Maharashtra
Punjab
Telangana
Uttar Pradesh
Gujarat
Delhi
Uttarakhand
Jharkhand
Mizoram
Tripura
Odisha
Haryana
Chhattisgarh
Chandigarh
Bihar

Figure 3.6.2: State/UT-wise number of district hospitals (n=182) with bed occupancy rate
of 90% or higher
Ladakh
Jammu and Kashmir
Himachal Pradesh
PunjabChandigarh
Uttarakhand
Haryana
Sikkim

Assam
Nagaland
Bihar
Meghalaya
Manipur
Jharkhand Tripura
West Bengal Mizoram
Madhya Pradesh
Gujarat
Chhattishgarh
Odisha
Maharashtra
Telengana
Andhra Pradesh
Goa
Karnataka
Andaman & Nicobar
TamilnaduPuducherry
Legend
Kerala
% of DHs with at least 80% bed occupancy
Lakshadweep
0.0
0.0 - 22.2
22.2 - 36.0
36.0 - 66.7
0 87.5 175 350 525 700 66.7 - 100.0

Miles
Figure 3.6.3: Percentage of district hospitals in each State/UT that have a bed occupancy
rate of at least 80 per cent

As mentioned before, IPHS 2012 recommends a bed occupancy rate of at least 80%. The
percentage of district hospitals in each State/UT that meet this criterion is illustrated in Figure
3.6.3. Table 11 lists the top performing district hospitals in the country by hospital size category
with the highest bed occupancy rate of up to 100%.26
Table 11: Top performing district hospitals in the country that have a bed
occupancy rate up to 100%
Paralakhemundi, Gajapati, Balangir, M. R. Bangur DH & SSH, South

Odisha Odisha Twenty Four Parganas, West Bengal
(100% bed occupancy rate) (100% bed occupancy rate) (99.20% bed occupancy rate)
Bandipora, Jammu DH Tenali, Guntur, Andhra DH SDN Hospital,

and Kashmir Pradesh Shahdara, Delhi
Deogarh, DH Vidisha, Vidisha, Madhya Shimoga District Hospital, Shimoga,

Odisha Pradesh Karnataka
National average: 66%

Range: 0–365.2%

M R Bangur Hospital, situated in the South 24 Parganas of West Bengal, categorized under large
hospitals, attribute their high performance to a no refusal to admissible patient policy. It started
functioning with a bed capacity of 500 and has gradually increased it to 625 over the years. In
addition to availability of multi-specialty services, the hospital has a 24X7 Pharmacy Service,
Blood Bank Service and PPP diagnostic Services like Echo, MRI, CT, Laboratory, 60-bedded
dialysis among others. Numerous efforts to keep waiting time and referrals to a minimum,
hygiene management, 24x7 grievance redressal cell have improved the performance of the
district hospital.
DH Bandipora, a newly upgraded District Hospital, is located in the northern border district
of Kashmir valley. The administration undertook key measures to utilize the limited space and
staff of the hospital, such as incorporating a time bound initial assessment and reassessment
schedule resulting in a timely discharge policy for the patients. Maintenance and upkeep of
medical equipment also paved way for decreased turn-around time for test results. All this has
led to a reduction in the average length of stay in the hospital and creation of space for new
patients. All these measures were diligently monitored and followed. Furthermore, new staff
positions were sanctioned which have increased the footfall and narrowed down the doctor/
nurse to patient ratio. Strong advocacy and IEC regarding availability of services was done for
improving admissions.
26 In case two or more hospitals had identical bed occupancy rates, their composite score (average of the scaled
values of all the 10 KPIs) was referred to, and the hospital with a higher composite score was regarded as a top
performing hospital for this particular indicator.

Dynamic steps were undertaken by the Head of Departments in DH Tenali, Andhra Pradesh to
improve patient services. Overall, they ensured quality patient care provided by the doctors
and nursing staff, early discharges of stable patients, increased day care procedures and
major surgeries, prompt attendance of doctors in trauma care and emergency services, and
simultaneously provision of quality diet, hygiene, and good sanitation facilities.
DH Vidisha, a mid-sized hospital in Madhya Pradesh, ensured that the infrastructure met NQAS
and Kayakalp standards of quality, facilitated regular training for doctors and staff, developed
standard operating protocols, improved quality of care, patient safety, all of which consequently
reduced hospital acquired infection rate and improved patient satisfaction. These measures also
helped ensure maximum bed occupancy.
Two small and one mid-sized hospital in Odisha have high bed occupancy rates in India. In
Balangir District Hospital, the patient footfall has been increasing every day and has touched
approximately 9,000 to 10,000 inpatient bed days per month. Patients cannot be cured of
disease only with medicine; there is also need of appropriate ambience/ improved facilities. The
staff are pushed to follow respectful patient care. District Headquarter Hospital Paralakhemundi
utilizes the Ishikawa (Fishbonc Diagram) technique for brainstorming and mind mapping to
discover the cause-and-effect relationship of any identified underlying problem to increase
patient satisfaction during their stay in the hospital. The focus shifted towards cleanliness
of wards, installation of air conditions, clean beds, adequate lighting, clean toilets, providing
mosquito nets, blankets, cooked balanced diet, Aahar scheme27 in hospital premises for the
attendants accompanying the patients. In District Headquarter Hospital, Deogarh too the
aforesaid key measures on housekeeping and cleaning upkeep, staff behaviour, laundry service,
availability of staff, counselling of patients, and the availability of patient centric services free
of cost have played a key role in ensuring a high bed occupancy rate.
Shimoga District Hospital, Karnataka is supervised by eminent specialists who ensure that the
hospital is well-equipped with all new technology, that all the specialities in the hospital are
operational 24×7, and that the entire staff is well-trained with respect to specialities. Patients
from within the district and surrounding districts come for treatments in large numbers. The
hospital therefore appointed specialists accordingly, and proactively filled any vacancies for
nursing and paramedical staffs. A new wing was constructed to cater to cardiology patients. The
OTs were upgraded with modern equipment and empanelled with Ayushman Bharat Schemes,
which is very helpful in giving free service to the poor people. Paperwork was minimized by
digitizing all work All of this contributed to an increase in OPD services, IPD services, and
emergency services.
“In SDN Hospital in Delhi Shahdara, shortage of manpower and HR vacancies
used to result in high workload on the existing staff, conversely resulting in longer
waiting periods and delayed admissions. However, this was addressed through timely
recruitment of staff and we were able to maintain high bed occupancy rates. During
the COVID-19 pandemic, the bed occupancy rate was as high as 110% with a 75%
patient satisfaction score.”
—Chief Medical Officer, SDN Hospital, Shahdara, Delhi
27 Aahar scheme is a food subsidisation program run by the Government of Odisha to provide cheap lunch to the
urban poor.

Recommendations to district hospitals

Ensuring 24×7 availability of support services, diagnostic testing facilities, pharmacy,
and well-planned shifts of medical and paramedical staff would contribute to an
optimal bed occupancy and resource utilization.
Regular maintenance and upkeep of medical equipment reduces its downtime and
increases its optimal utilization.
Periodic monitoring of processes will help analyse gaps and acts on addressing it
thereby eventually ensuring smooth processes, reduced waiting time, and redressal
of any other administrative lacunae.
Timely recruitment and prompt steps to fill HR vacancies will allow for larger numbers
of patient examinations.

3.7 C-SECTION RATE

This KPI lies in the domain of Output. The district hospital exercises control over this indicator.
It is calculated by dividing the number of Cesarean section deliveries performed in a year with
the total number of deliveries in the year. The figure is multiplied by 100 in order to express it
in percentage.
Number of C-section deliveries

performed in the year
C-section rate = × 100
Total number of deliveries in the year
(Normal + Assisted Deliveries + C Section)

Caesarean section (C-section) was introduced in clinical practice as a lifesaving procedure both
for the mother and the baby. C-section deliveries are absolutely critical to save lives in situations
where vaginal deliveries would pose risks, so all health systems must ensure timely access for
all women when needed. However, not all the C-sections carried out at the moment are needed
for medical reasons. Unnecessary surgical procedures can be harmful, both for a woman and
her baby. Both extremely low and extremely high rates of C-section deliveries pose adverse
effects within maternal health care,28 and therefore, observing the trend of the C-section rate
is crucial in identifying its reasons.
C-section deliveries are associated with longer hospital stays, delayed initiation of breastfeeding
and higher out-of-pocket expenses due to longer duration of stay.29 A high rate of C-section
deliveries can be associated with both short- and long-term risks which can extend for many
years beyond the current delivery and affect the health of the woman, her child, and future
pregnancies.30
3.7.3 Juxtaposition of the KPI with global standards

Globally, there is an ongoing debate on what should be the optimal rates of C-section deliveries.
As per a WHO report, “At population level, C-section rates higher than 10% are not associated
28 Lee, H-Y., Kim, R., Oh, J., & Subramanian, S. V. (2021). Association between the type of provider and Cesarean
section delivery in India: A socioeconomic analysis of the National Family Health Surveys 1999, 2006, 2016. doi:
10.1371/journal.pone.0248283
29 Dongre, A., Surana, M. (2018). C-section deliveries and the role of the private health sector in India (available at:
https://www.ideasforindia.in/topics/productivity-innovation/c-section-deliveries-and-the-role-of-the-private-health-sector-in-india.
html)
30 World Health Organization. (2015). WHO Statement on Cesarean Section Rates. (available at: http://apps.who.int/
iris/bitstream/10665/161442/1/ WHO_RHR_15.02_eng.pdf)

with reductions in maternal and newborn mortality rates.”31 However, there is no evidence
showing the benefits of C-section delivery for women who do not require the procedure. A
district hospital would receive multiple complicated cases of pregnancy that require performing
C-section surgery. The WHO states that every effort should be made to provide caesarean
sections to women in need, rather than striving to achieve a specific rate.

As mentioned above, cases that come to district hospitals are often emergency or complicated
cases. A surgical procedure cannot be avoided in such cases.
It is interesting to note the average percentage of C-section deliveries being performed in a
district hospital in India. Figure 3.7.1 gives a State/UT-wise distribution of this average, while the
same distribution by hospital size can be seen in Annexure 5. On an average, 20.8% C-section
deliveries are performed in a district hospital in India. In small hospitals having up to 200 beds
this average stands at 16.03%, mid-sized hospitals (201-300 beds) have an average of 25.08%,
while large hospitals (with more than 300 beds) have an average C-section rate of 31.3%.
55.15
53.51
48.79
44.22
43.46
42.74
39.76
38.82
37.09
35.76
34.69
34.46
33.70
33.10
32.21
25.48
24.01
23.22
20.80
21.14
19.69
18.99
17.50
17.38
16.47
15.87
14.64
14.58
12.43
12.21
10.73
10.58
11.48
11.12
8.35
5.85
5.36
5.13
Odisha
Telangana
India
Meghalaya
Goa
Tamil Nadu
Daman & Diu
Nagaland
Chandigarh
Maharashtra
Puducherry
West Bengal
Gujarat
Arunachal Pradesh
Manipur
Uttarakhand
Ladakh
Karnataka
Madhya Pradesh
A & N Islands
Tripura
Sikkim
Chhattisgarh
Bihar
Lakshadweep
Andhra Pradesh
Assam
Mizoram
Delhi
Jharkhand
Uttar Pradesh
Kerala
Punjab
Rajasthan
Jammu & Kashmir
Haryana
Himachal Pradesh
Figure 3.7.1: Average percentage of C-section deliveries in a district hospital by State/UT
Figure 3.7.2 represents the count of district hospitals in each State/UT with C-section rate of
less than 35%. Of the 707 hospitals, 450 district hospitals performed less than 35% C-section
deliveries.
31 World Health Organization. WHO Statement on Cesarean Section Rates, 2015, Available from: http://apps.who.int/
iris/bitstream/10665/161442/1/ WHO_RHR_15.02_eng.pdf.
Souza J, Gulmezoglu A, Lumbiganon P, et al. Cesarean section without medical indications is associated with an
increased risk of adverse shortterm maternal outcomes: the 2004-2008 WHO global survey on maternal and
perinatal health. BMC Med. 2010;8:71.

47
34
27 27
23
20
17 17 17
15
13 14
10 10 10 10 11
7
5 6 6 6
2 2 3 3 4
1 1 1 1 1 1
Nagaland
Chandigarh
Meghalaya
Odisha
A & N Islands
Ladakh
Telangana
Karnataka
Daman & Diu
Tamil Nadu
Tripura
Assam
Puducherry
Arunachal Pradesh
Manipur
Kerala
Mizoram
Uttarakhand
Maharashtra
Gujarat
Jharkhand
Sikkim
Himachal Pradesh
Jammu & Kashmir
Punjab
Andhra Pradesh
Chhattisgarh
Delhi
Bihar
West Bengal
Rajasthan
Haryana
Madhya Pradesh
Figure 3.7.2: Number of district hospitals by State/UT having C-section rate less than 35%
Note: As Uttar Pradesh and Uttarakhand have separate hospitals for men and women & children, the C-section rate
for male hospitals in recorded as 0; hospitals that were unable to provide data also have been assigned a value of 0.
Table 12 lists the hospitals that have the highest C-section rate among district hospitals in the
country within each hospital category. The district hospitals having the highest C-section rate
in each State/UT is listed in Annexure 4.
Table 12: District hospitals in India with the highest C-section rate
Bijapur District Hospital FRU, DH Machilipatnam, Krishna,

Bijapur, Karnataka Andhra Pradesh
(100% C-section deliveries) (73.34% C-section deliveries)
District Hospital JNLM, Srinagar, DH Karimnagar, Karim Nagar,

DH Aluva, Ernakulam, Kerala
Jammu and Kashmir Telangana
(67.04% C-section deliveries)
(90.8% C-section deliveries) (69.93% C-section deliveries)
DH Khammam, Khammam, DH Nagapattinam,

Telangana Nagapattinam, Tamil Nadu
(65.42% C-section deliveries) (68.77% C-section deliveries)
National average: 20.8%

Range: 0-100%
MEASURES UNDERTAKEN IN DISTRICT HOSPITALS WITH HIGH RATE

OF C-SECTION DELIVERIES
JLNM Hospital in Srinagar followed a multidisciplinary approach to effectively improve on
existing infrastructure and manpower including gynaecologists, medical officer, nursing staff and
other support staff who were available round the clock. The regional hospital has well equipped
Maternity Operation Theatres (OTs), including one emergency OT, for management of C-section
deliveries. Due to the hospital’s referral policy, it receives complicated cases from other district
hospitals so as to avoid congestion in medical college hospitals. The facility provides all the

drugs, consumables, diagnostics, diet and other entitlements as envisaged under JSSK free
of cost to the obstetric patients. These measures have made it possible to conduct C-section
deliveries around the clock.
“Integrating the health infrastructure with sufficient support services,

availability of fully functional blood bank and special newborn care
unit (SNCU) helped clinicians in managing high risk delivery cases
in the hospital.”
—District Surgeon,
JLNM Hospital, Srinagar
Lack of awareness regarding the benefits of a normal delivery and fear of labour pains forced
women in Karimnagar and Khammam District Hospitals, Telangana to opt for C-section deliveries.
The hospitals included one-to-one counselling of women by medical officers, obstetricians and
ANMs, and regularly conducted meetings in presence of MD, NHM of the state. This has led to
improved awareness and positive attitude in favour of normal deliveries.
Initially, District Hospital Machilipatnam in Krishna district of Andhra Pradesh, had limited space
for inpatients which led to a decline in their turnover. Limited gynaecologists, staff nurses,
supporting staff, operation theatres all led to issues in management of antenatal mothers. To
address these issues, the hospital increased the bed availability by developing a newly built full-
fledged MCH block with facilities like LDRs, HDUs, and well-equipped OTs. Number of specialists
were increased by appointing new gynaecologists, anaesthetists, general duty medical officers
in addition to support staff, and making them available round the clock under strengthening
of MCH services. The Dakshatha training, specifically designed to improve care and survival of
mothers, made the facility’s service delivery efficient. All these actions decreased referrals and
increased performance of the hospital.
Bijapur District Hospital in Karnataka appointed new specialists and created a separate MCH wing
with support from the State and local administration, which was followed by NQAS certification.
Good leadership, high staff motivation, regular training to identify early complications and
sustainability of quality care services are some of the key factors which have helped in achieving
minimal post-operative complications, less than 0.5% surgical site infection, low MMR and IMR.
District Hospital Aluva in Ernakulam district, Kerala also adopted a similar approach to increase
the overall deliveries, while also ensuring an improvement in the gynaecology services provided
by the department. The administration tackled two key issues — inadequate staff strength and
scope for improvement in the infrastructure. Consequently, both normal and C-section deliveries
saw an increase, coupled with reduction in maternal and infant deaths.
The staff in Nagapattinam District Hospital, Tamil Nadu worked in co-ordination with field-
level staff and mentored them for identification of high-risk cases at the earliest, follow-up,
and referral at appropriate time. A constant communication link was maintained with the
sub-district hospitals and higher referral centers for proper guidance and timely referral. The

doctors on duty were put on alert and were informed at the earliest of the likely patients
who may turn up for delivery. There was regular training and mentoring sessions, and a
separate team of nurses was created for postnatal care and post-operative care. Shortage
in manpower was addressed by putting in place schemes to hire private specialists such as
obstetricians and gynaecologists.

The proportion of caesarean sections at the population level is a measure of the
level of access to and use of this intervention. It can serve as a guideline for policy-
makers and governments in assessing progress in maternal and infant health and in
monitoring emergency obstetric care and resource use.
The C-section rate is a result of varied contextual factors, which should be analysed
so that tailored interventions can be implemented to stabilize the rate at large.
Leveraging the ANM–ASHA–Anganwadi Worker (AAA) network, institutional
deliveries over home deliveries should be encouraged and ensured. At the same
time, the primary health centres (PHCs) and community health centres (CHCs) should
be strengthened to cater to these deliveries and only emergency cases should be
referred to district hospitals for C-section. Further, the National Ambulance Service
must cater to emergency reference cases.
Overall, efforts must be made to reduce maternal and infant deaths. At the same
time, hospitals must adhere to the norms of complications that allow for a C-section
rather than a vaginal delivery.

3.8 SURGICAL PRODUCTIVITY INDEX

This is an Output indicator. For the purpose of this assessment, this KPI is calculated by dividing
the total number of major surgeries performed in a year (excluding the surgeries related to
Obstetrics, Gynaecology and Ophthalmology) with the number of surgeons in the hospital.
This data element would be calculated by subtracting the surgeries related to Obstetrics,
Gynaecology and Ophthalmology from the total number of major surgeries performed at the
District Hospital.
This KPI is largely under the control of the district hospital.
Total number of major surgeries in a year

 excluding obstetrics/gynaecology 
 and ophthalmology surgeries 
Surgical productivity index =
Total number of surgeons
 excluding obstetric/gynaecological 
 surgeon; ophthalmologist; dental surgeons

Many different surgical societies define a minimum number of surgical procedures to acquire
and maintain surgical competence, though this varies from country to country. The Operations
Rooms (ORs) in the surgical centres are critical units in a hospital management.32 They are
directly related to the larger function of a hospital production system, which is the intervention
to restore the patient’s health. They represent a large part of the hospital income and costs.
Also, ORs have a complex environment where the tolerance for mistakes is extremely low and
they can have a limited capacity to the number of available ORs, materials, human resources,
and equipment. 33 In this context, it is essential to develop tools that show how to improve and
analyze the OR’s efficiency.

A total of 177 district hospitals from 27 States/UTs fell in the upper quartile for Surgical
Productivity Index, which included hospitals performing more than 205 surgeries per surgeon
per year. The top share of hospitals is occupied by the States/UTs of Uttar Pradesh (21.9%),
followed by Rajasthan (6.7%), and Delhi (6.2%) (see Figure 3.8.1).
32 Souza, T.A., Roehe Vaccaro, G.L. and Lima, R.M. Operating Room effectiveness: a lean health-care performance
indicator. International Journal of Lean Six Sigma, Vol. ahead-of-print No. ahead-of-print. https://doi.org/10.1108/
IJLSS-12-2017-0141. (2020).
33 Cima, R.R., Brown, M.J., Hebl, J.R., Moore, R., Rogers, J.C., Kollengode, A. and Team, S.P.I. Use of lean and six sigma
methodology to improve Operating Room efficiency in a high-volume zertiary-care academic medical center”,
Journal of the American College of Surgeons, Vol. 213 No. 1, pp. 83-92. (2011).
Demeulemeester, E., Beliën, J., Cardoen, B. and Samudra, M. Operating Room planning and scheduling”, in Denton,
B.T. (Ed.), Handbook of Healthcare Operations Management, Springer, New York, NY, pp. 121-152. (2013).
Rothstein DH, Raval M V. Operating Room efficiency. Seminars Pediatric Surgery. Vol. 27(2):79–85, (2018).

Figure 3.8.2 gives a State/UT-wise distribution of the average number of surgeries per surgeon
in a district hospital, while the same distribution by hospital size may be found in Annexure
5. On an average, 194 surgeries per surgeon are performed in a year in a district hospital in
India. In small hospitals having up to 200 beds this average stands at 140, mid-sized hospitals
(201-300 beds) have an average of 262, while in large hospitals (with more than 300 beds) a
surgeon performs an average of 300 surgeries in a year.
39
12 11
10 10 9 9 9
8 8 8 7
5 5 4 4 4 3 3 2 1 1 1 1 1 1 1
Madhya Pradesh
Meghalaya
Uttar Pradesh
Odisha
Uttarakhand
Rajasthan
Delhi
Tamil Nadu
Jammu & Kashmir

Karnataka
Maharashtra
Bihar
Haryana
West Bengal
Kerala
Telangana
Assam
Goa
Mizoram
Puducherry
Gujarat
Punjab
Chhattisgarh
Himachal Pradesh
Andhra Pradesh
Chandigarh
Figure 3.8.1: State/UT-wise distribution of number of district hospitals (n=177) in the upper
quartile for surgical productivity index
547
491
481
439
307
300
314
298
295
266
240
242
242
235
229
215
194
165
162
156
147
125
121
98
94
90
73
63
71
46
47
43
30
29
24
21
7
2
Odisha
Nagaland
Telangana
Arunachal Pradesh
Delhi
Tamil Nadu
Bihar
Karnataka
Goa
India
Meghalaya
Ladakh
Kerala
Gujarat
Uttar Pradesh
Madhya Pradesh
Daman & Diu
A & N Islands
Puducherry
Maharashtra
Mizoram
Rajasthan
Jammu & Kashmir
Punjab
West Bengal
Uttarakhand
Assam
Jharkhand
Manipur
Tripura
Sikkim
Chandigarh
Lakshadweep
Haryana
Andhra Pradesh
Chhattisgarh
Himachal Pradesh
Figure 3.8.2: Average number of surgeries per surgeon performed in a year in a district
hospital by State/UT

Table 13 lists the top performing district hospitals in the country by hospital size for the KPI
surgical productivity index. The top performing district hospital in each State/UT for this KPI
is listed in Annexure 4.
“surgical productivity index”
Sanjay Gandhi Memorial Hospital

Hedgewar Hospital, Mangolpuri, North West, Delhi
Shahdara, Delhi
(4523 surgeries per surgeon in a year)
(1823 surgeries per surgeon in Chickmagalur District
Sadar Hospital Saharsa, Saharsa, Bihar Hospital FRU,
a year)
(3587 surgeries per surgeon in a year) Chikmagalur, Karnataka
(2236 surgeries per
Tej Bahadur Sapru Hospital, surgeon in a year)
Mandi Zonal Hospital, Mandi,
Prayagraj, Uttar Pradesh
Himachal Pradesh
(1686 surgeries per surgeon in
(1424 surgeries per surgeon in a year)
a year)
National average: 194 surgeries per surgeon in a year

Range: 0–4523

Chikmagalur District Hospital FRU, Chikmagalur, Karnataka allows all surgeons to perform
surgeries on all days, including out of OPD / duty hours. To document all surgeries, an e-hospital
portal was implemented and all procedures that were performed were registered. More recently,
the Ayushman Bharat – Arogya Karnataka (ABArK) scheme has been influential in contributing
to the number of surgeries done - doctors are encouraged to operate 24x7 with paid incentives
(including ABArK).
Sadar Hospital Saharsa in Bihar conducted detailed gap assessments of their infrastructure and
services, renovated the OT by adhering to the NQAS checklist and incorporating feedback from
the surgeons, and ensured regular capacity building of the dedicated staff.
The hospital is an old building and the OT had very poor infrastructure
and lacked a functional quality team. After conducting gap assessments,
the OT was renovated and a quality circle team was formulated — they
were oriented with quality tools like clinical discussion, PDCA cycles,
review meetings with paramedical staff, support staff and surgeons.
The Deputy Superintendent and Hospital Manager conduct regular and
random inspections for quality checks.
—Sadar Hospital Saharsa

Civil Surgeon (Dist.: Saharsa, State: Bihar)

Pre-intervention, there was no mechanism for scheduling surgeries in the OT at Saharsa

hospital, resulting in overcrowding of patients, unavailability of surgeons, and conflicts between
the hospital staff and the patients’ representatives. A management team and supporting
administrative staff were roped in for OT scheduling in coordination with surgeons. Surgeon-
wise days were fixed for operative procedures and waiting time was reduced by mapping end-
to-end processes from registering of a patient till transfer of a patient to the ward. Patients
have been providing positive feedback on the Mera Aspataal portal, a MoH&FW, GoI initiative
to capture patient feedback for the services received at the hospital.
Shri Tez Bahadur Sapru Hospital in Prayagraj, Uttar Pradesh, established in 1909, is a combination
of modern and ancient architecture. It caters to the medical demand from nearby districts
as a multispecialty referral centre. It provides a wide range of curative health care services
ensuring quality and cost-effectiveness. The optimal performance of one indicator depends on
the optimal performance of other related indicators. To complement a high rate of surgeries per
surgeon, the hospital also has a high bed occupancy rate and more than 2500 OPD patients
every day. Facilities such as diagnostic testing services, e-hospital, ambulance service, public
announcement system, etc. are well maintained. Along with declaration of the best employee
of the week in the hospital, vocational training of personnel is conducted regularly through
technical training sessions and workshops, and an employment satisfaction index is maintained.
Sanjay Gandhi Memorial Hospital in Mangolpuri, North West Delhi caters to a population of
25 lakh and has a huge inflow of patients. Initially, junior specialists would resign in short time
periods, making it difficult to run OTs in full capacity. Moreover, appointments for surgeries were
given with a waiting period of more than one month. To address this, the hospital ensured regular
recruitment of doctors, senior residents, and junior residents. More recently, DNB graduates are
being given separate training after gaining approval of the national board. Their intake proved
helpful in running the OPD, preparing the OT for surgeries, taking follow-ups, etc., thereby
strengthening the surgical teams. Further, OT days for each department were increased. Case
discussions are done regularly so as to avoid repetition of any lapse.
The result is owing to team work of the surgical team comprising

of six non-teaching specialists with approximately 25 SRs from
respective departments, along with three anaesthetists. For them
to run the show serving the underprivileged from Delhi as well as
other states and regions is commendable.
—Quality Nodal Officer,
Sanjay Gandhi Memorial Hospital, North West Delhi
Hedgewar Hospital, Shahdara, Delhi focuses on optimal usage of OTs by engaging in

communication with the patients and pre-planning surgeries and following a transparent
procedure in booking an OT for surgery. Patient data was computerized and mobile number
of the patient’s point of contact was recorded for direct coordination. Improved coordination
between the internal departments and timely procurement of surgical material were key in
enabling a high number of surgeries.

Mandi Zonal Hospital, Himachal Pradesh has two functional OTs for round the clock services
with all diagnostic and lab investigations, which helped in scheduling operations at any hour
of the day. Maintenance of surgical instruments, training the support staff in using them, and
keeping the OT open 24×7 contributed to the increasing number of surgeries.

Providing logistic support including operation theatre facilities, manned by trained
nursing staff and paramedical support staff, and necessary surgical items helps
specialists to provide round the clock services.
Access to specialists from nearby medical colleges/ on contract specialists leads
to providing necessary services from different specialties at the DH. This leads to
improved access by rural populations and decreases regional disparities in access
to specialist services.

3.9 OPD PER DOCTOR

This indicator is classified under Output. It is a proxy indicator for accessibility and utilization
of health services that may reflect the quality of services. It is calculated by dividing the total
number of OPD patients in a year with the number of OPD days and the total number of
positioned doctors. The district hospital largely exercises control over this KPI.
Total number of OPD patients in a year (Allopathic + AYUSH)

OPD per doctor =
Number of positioned doctors × OPD days in that year

According to WHO, there is one doctor for every 1,445 Indians as per the country’s current
population estimate of 135 crore, which is lower than the WHO’s prescribed norm of one doctor
for 1,000 people.34 In a tertiary care facility such as Post-Graduate Institute of Medical Education
& Research, Chandigarh about 500 new patients are registered daily in the OPD, and ideally each
new patient requires about 15 to 30 minutes.35 Super specialty clinics in government hospitals
are over worked and under staffed with heavy patient load. There should be adequate number
of doctors to attend to expected patient load so that doctors can give adequate time and
quality treatment to patients, which is the basic right of every patient.36 By measuring the OPD
patients per doctor for district hospitals, inter-district comparisons can be made accounting
for factors such as population, accessibility of the district hospital, etc. This will give insights
on resource allocation and will enable more informed decision-making.

To characterize the number of OPD patients attended in a district hospital per doctor in a day,
the data was divided into quartiles. Figure 3.9.1 depicts the percentage distribution of a total
of 177 out of 707 hospitals falling in the upper quartile (75th percentile) that included hospitals
with more than or equal to 34 OPD patients per doctor in a day. Uttar Pradesh (49.2%) had
the highest proportion of hospitals with ≥34 OPD patients per doctor, followed by Tamil Nadu
(12.4%), Bihar (7.3%), Karnataka (4.5%), and Delhi (3.4%).
34 Economic Times. (2019). Doctor-patient ratio in India less than WHO-prescribed norm of 1:1000: Govt (available
at: https://health.economictimes.indiatimes.com/news/industry/doctor-patient-ratio-in-india-less-than-who-
prescribed-norm-of-11000-govt/72135237)
35 The Indian Express. (2015). PGI faculty writes to director, seek fixing of doctor-patient ratio (available at: https://
indianexpress.com/article/cities/chandigarh/pgi-faculty-writes-to-director-seek-fixing-of-doctor-patient-ratio/)
36 Pandey, A., Singh, A., Singh, S., & Kumar, A. (2019). Patient-doctor ratio across nine super speciality clinics in
government hospital: a cross sectional study. International Journal of Community Medicine and Public Health 6(10).
doi: 10.18203/2394-6040.ijcmph20194505

87
22
13
8 6 6 6 5 5 3 2 2 2 2 2 1 1 1 1 1 1

Uttar Pradesh
Karnataka
Delhi
Gujarat
Madhya Pradesh
Haryana
Himachal Pradesh
Rajasthan
Telangana
Odisha
Jammu & Kashmir
Maharashtra
Uttarakhand
Kerala
West Bengal
Puducherry
Bihar
Punjab
Tamil Nadu
Chandigarh
Figure 3.9.1: State/UT-wise distribution of number of district hospitals (n=177) having
doctors attending to 34 or more OPD patients per day
Figure 3.9.2 gives a State/UT-wise distribution of the average number of OPD patients per
doctor in a district hospital, while the same distribution by hospital size can be seen in Annexure
5. On an average, 27 OPD patients are attended to by one doctor in a day in a district hospital
in India. In small hospitals having up to 200 beds this average stands at 28, mid-sized hospitals
(201-300 beds) have an average of 27, while in large hospitals (with more than 300 beds) a
doctor attends to an average of 26 OPD patients in a day.
47
43 43
38
35 34
32 30 30 29
28 28 27 27 27 27
23 22
21 19 19
17 17 16 15
14 14 14 13
11 10 9
8 6 6
5 5
Dadra & Nagar…
Madhya Pradesh
Odisha
Meghalaya
Goa
India
Telangana
Nagaland
Tamil Nadu
Gujarat
Daman & Diu
West Bengal
Jharkhand
Arunachal Pradesh
Manipur
A & N Islands
Mizoram
Uttar Pradesh
Bihar
Karnataka
Delhi
Kerala
Lakshadweep
Maharashtra
Tripura
Uttarakhand
Assam
Rajasthan
Chhattisgarh
Sikkim
Himachal Pradesh
Punjab
Puducherry
Haryana
Jammu & Kashmir

Chandigarh
Andhra Pradesh
Figure 3.9.2: Average number of OPD patients per doctor in a day in a district

Table 14 lists the top performing district hospitals in the country by hospital size for the KPI
OPD per doctor. The top performing district hospital in each State/UT for this KPI is listed in
Annexure 4.
“OPD per doctor”
District Women Hospital, Mau, Walajapet, Vellore,

Uttar Pradesh Tamil Nadu
(206 OPD patients per doctor) (130 OPD patients per doctor) DH Bhind, Bhind,
Madhya Pradesh
DH Botad, Botad, Malkhan Singh District Hospital, (312 OPD patients per doctor)
Gujarat Aligarh,
Uttar Pradesh
(134 OPD patients per doctor)
(104 OPD patients per doctor) Balrampur Hospital,
Lucknow, Uttar Pradesh
RNM District Joint Hospital, Periakulam, Theni, (193 OPD patients per doctor)
Firozabad, Uttar Pradesh Tamil Nadu
(123 OPD patients per doctor) (103 OPD patients per doctor)
National average: 27 OPD patients per doctor in a day

Range: 0.05–326.5

One large, one mid-sized, and two small hospitals in Uttar Pradesh have a high score of OPD
per doctor compared to the rest of the district hospitals in the country.
Balarampur Hospital in Lucknow district is Uttar Pradesh’s largest and most renowned hospital.
Owing to variety of specialties and super-specialties available here, many complex cases are
referred here from different districts of the state. The hospital provides OPD services and indoor
medical services round the clock on all days, except Sundays and National Holidays. The hospital
has a well-equipped OT wherein General Surgery, Urosurgery, Neurosurgery, Orthosurgery, ENT
and Ophthalmic surgeries are performed. In addition, it also operates an emergency OT. Given
the access to services, the hospital witnesses more than 2500 patients for treatment every day
in the OPD translating into a high OPD per doctor score.
Malkhan Singh District Hospital, a mid-sized hospital in Aligarh, witnesses a high footfall
of around 1500 new and 1200 old patients daily for treatment. The bed occupancy rate for
hospitalization generally remains 100% and on an average 10 to 15 major surgeries are performed
every day in the hospital.
Rajnarayan Maheshwari Government Hospital is a 100-bedded hospital situated in the Firozabad
district of Uttar Pradesh. The facility provides services to the rural population and witnesses
more than 1800 OPD patients every day. More recently, the hospital has also been witnessing
upward growth fueled by funding from Ayushman Bharat Yojana in the last few years.

The District Female Hospital in Mau district is a 100-bedded facility for women, which attends
to more than 300 OPD patients on a daily basis. On average, 1–2 major surgeries (C-section)
and 3–5 minor surgeries are performed every day. The hospital has 24*7 availability of pathology
services.
In Botad District Hospital, Gujarat, one of the driving forces enabling doctors to attend to a
high number of OPD patients was efficient implementation of the Government of Gujarat’s
CM-SETU Yojana (Chief Minister Services of Experts at Treatment Unit). There were only two
specialists in 2016–17. Thus, specialist medical services were limited. Also, posts of Medical
Officers were vacant. Through the CM-SETU Yojana, private gynaecologists, surgeons, physicians,
orthopaedicians, ENT surgeons, ophthalmologists were recruited to visit the hospital on fixed
days and for a defined duration. Thus, multi-specialty OPDs were started and this led to an
increase in OPD patients at the centre. To sustain the improved footfall, a full-time gynaecologist
and surgeon were also appointed, and posts of nursing staff and other support staff were also
filled.
“Availability of human resources helped improve service availability

and utilization. Further, to capitalize on this, the district hospital
organized various camps such as for NCD awareness, disability
certification, ENT check-ups, etc. This was compounded with
extensive IEC in local mass media and print media to make people
aware of the available services and increase their utilization.”
—State Health Systems Resource Centre, Gujarat
“Periyakulam GHQH in Theni district has a high number of OPD

patients per doctor owing to many factors – while the patient
footfall is generally high in the OPD, there is a separate OPD wing
in the hospital with online registration facility. Additionally, there
are separate registration counters for men, women, and children,
separate consulting and injection rooms, 24×7 laboratory, 24×7
pharmacy, a separate dispensary for NCDs, facility for ECG, USG
scan, digital X-ray, among others. Due to the availability and
maintenance of facilities, waiting time is limited and doctors are
able to attend to more patients.”
—Joint Director, Medical and Rural Health Services,
Theni, Tamil Nadu
DH Bhind, a 300-bedded hospital in Madhya Pradesh, has enhanced the hospital infrastructure
to improve patient services. By developing digital sign boards, conducting behaviour training of
the doctors, and strengthening the implementation and monitoring of the Mera Aspataal portal,

patient satisfaction saw gradual improvement. Facilitating government schemes for the patients
also helped reduced their out-of-pocket expenditure. Overall, footfall of patients continued to
grow, while doctors were trained in effective management of patients.
Walajapet DH in Vellore, Tamil Nadu undertook regular exercises to map the gaps and the
critical processes that are carried out, analysed waiting time, and prepared an improved process
mapping. These activities also helped meet LaQshya and other NQAS requirements. The staff
is punctual, cordial, and respectful towards patients, all of which contribute to being able to
treat as many patients as possible.

Hospitals should encourage care seeking among the community through extension services,
as also make seeking care a hassle-free and productive experience. Tele-medicine services
can help increase OPD footfalls, with convenience to patients.
Work flow in OPDs, and functioning of departments needs to be so organized so as to limit
waiting time, increase speed of reporting of test results, and high quality consultations, as well
as outdoor procedures wherever feasible.
For maximal utilization of the infrastructure of public hospitals, provision should be made for both
morning and evening OPDs. The necessary staff, equipment, and space should be provisioned
for running such clinics and diagnostic set-up. Evening OPDs shall have the added advantage
of obviating “opportunity costs” for the poor who have to miss their daily wage to attend to the
hospital in the morning.37
37 Bajpai, V. (2014). The challenges confronting public hospitals in India, their origins, and possible solutions. Advances
in Public Health, Article ID 898502. doi: 10.1155/2014/898502

3.10 BLOOD BANK REPLACEMENT RATE

This KPI is categorized under Output. It falls under the control of the district hospital.
It is calculated by dividing the total number of blood units issued on replacement in the year
by the total number of blood units issued in that year and then multiplied by 100.
In this indicator, blood units issued in a year includes voluntary donation replacement. Number
of blood units issued on replacement donation means that a patient’s attendant is being asked
to give blood units, for getting blood from the blood bank. Replacement needs to be phased
out as the replacement donor has a chance of higher sero-positivity (giving a positive result in
a test of blood serum, e.g. for the presence of a virus.)
This indicator has negative valence, implying that lower the score, better the performance.
Total number of blood units

issued on replacement in the year
Blood bank replacement rate = × 100
Total number of blood units issued in year

An important aspect of patient care is the provision of safe and quality blood collection from
voluntary donors at an affordable cost to the general public and free of cost to the poor. Hence,
this indicator measures the ability of the hospital to provide as well as manage the supply of
blood from low-risk donors.
It helps in identifying how much voluntary replacements are made and how many are paid. In
an ideal situation the blood bank should be replenished with voluntary donations rather than
asking the patient’s caretakers to replace the blood units being issued to the patient. The idea
behind measuring this indicator is to encourage voluntary donations and maintain a replenished
blood bank. The spirit is not to refuse blood units by the patients’ caretakers when issued, but
also not insist upon replacing the blood units issued.

This segment presents data on a total of 554 out of 707 district hospitals; as the remaining
hospitals were unable to produce accurate records for this indicator, which were therefore
excluded from the analysis. On an average, 35% blood units are issued on replacement in a
year in a district hospital. Among the small hospitals, the national average stands at 39.49%.
In mid-sized hospitals, this figure is 33.89%. In large hospitals, 25.57% blood units are issued
on replacement. The State/UT-wise average percentage of the blood bank replacement rate is
presented in Figure 3.10.1. The States/UTs are arranged in ascending order, with a lower score
indicating better performance.

96
66
58
49 51 52
42 42 45 46 47
35 37 37 38
26 27 27 28 31
21 22 22 23
12 14 16 16 17 19
6 9 10
0 1 2 2 4
Dadra & Nagar…

Nagaland
Madhya Pradesh
Goa
Meghalaya
Telangana
India
Odisha
Tamil Nadu
Daman & Diu
Gujarat
A & N Islands
West Bengal
Maharashtra
Arunachal Pradesh
Uttarakhand
Manipur
Sikkim
Karnataka
Puducherry
Ladakh
Jharkhand
Lakshadweep
Kerala
Jammu & Kashmir

Mizoram
Uttar Pradesh
Delhi
Bihar
Punjab
Tripura
Rajasthan
Assam
Haryana
Himachal Pradesh
Chhattisgarh
Chandigarh
Andhra Pradesh
Figure 3.10: Average number of blood units issued on replacement in a year in a district
Table 15 lists the district hospitals in the country that have the least number of blood units
issued on replacement against the total number of blood units issued in the year.38 The district
hospital having the least blood bank replacement rate in each State/UT is listed in Annexure 4.
Table 15: Top performing district hospitals in the country that have a blood
bank replacement rate of 0%
Usilampatti, Madurai, Civil Hospital, Panchkula, GH Ernakulam, Ernakulam,

Tamil Nadu Haryana Kerala
Civil Hospital, Hisar, Haryana Alibag, Raigarh, Maharashtra Belgaum District Hospital,
Belgaum, Karnataka
Padhmanabapuram, Mettur Dam, Salem, VIMS Bellary Medical College,

Kanniyakumari, Tamil Nadu Tamil Nadu Bellary, Karnataka
National average: 26.94% blood units issued on replacement

Range: 0–100%

Civil Hospital Hisar, Haryana have collaborated with various NGOs/blood donation camp
organizers, out of which some are very active. The hospital tries to never miss any opportunity
to organize voluntary blood donation camps whenever offered by any organization. Every
Sunday has been mandatorily fixed to conduct blood donation camps on field. Days of national
importance are also celebrated by organizing blood donation drives.
38 Similar to the method adopted for other indicators, if two or more hospitals had the same raw score, the hospital
with a higher composite score (average of the scaled values of all 10 KPIs) was regarded as the better performing
district hospital.

Civil Hospital Panchkula, Haryana provides 24x7 Blood Bank services to the indoor patients,
private hospitals, and nursing homes in the region. It encourages 100 per cent voluntary donation
by arranging camps regularly — about 55–60 camps annually. Blood is issued without any
replacement to those in need. A directory of Voluntary Blood Donors is also maintained and in
case of emergency or during times of low availability, donors are contacted directly. There is also
availability of transfusion services round the clock. The hospital maintains an association with
the Sarpanchs of villages of Panchkula and they conduct camps and outreach activities in their
village after every 3–4 months for Blood Donation camps. In addition to organizing regular blood
donation activities throughout the year, the hospital has been educating potential blood donors
and camp organizers regarding the technical aspects of these activities, specifically about the
limited shelf life of blood units. These measures help the hospital in ensuring an average amount
of blood stock throughout the year thereby meeting maximum number of requests.
It is very difficult to counsel the donors on a regular basis. One of our

measures is to motivate the donors to become regular donors for
lifetime by highlighting the importance of donation and recruitment
of the donor. We also conducted awareness through social media
webinars lecture/PPT presentation in the local language. This
created a positive impact from the donors which enhanced their
performance.
—Transfusion medicine specialist,
Belgaum District Hospital, Karnataka
One of the main interventions through which VIMS Bellary Medical College, Bellary dist.,
Karnataka ensured a low blood bank replacement rate was spreading awareness amongst the
youth. VIMS blood bank works closely with various educational institutes on spreading awareness
of voluntary blood donations and the numerous advantages it has. Many competitions were held
in colleges with the help of the District AIDS Prevention and Control Unit where voluntary blood
donations was the main topic. VIMS also worked with PHCs, wherein ASHA workers played a
huge role in motivating people to donate blood.
With increased number of blood storage centres in the district we

were able to conduct more number of voluntary blood donation
camps in the villages, where the number of donors went up from
initial 1-2 to 50 donors per camp.
—Blood bank officer, VIMS Hospital, Bellary
Pre-intervention, there was lack of knowledge about importance of blood and blood donation
in saving lives, coupled with lack of motivation for voluntary blood donation amongst people.
Limited or no coordination and cooperation between governmental and non-governmental
organisations also is a contributing factor in suboptimal blood donation.

With concerted efforts professional and replacement donors are

completely eliminated, and there has been an increase in the
number of voluntary donors as well as blood availability, thereby
ensuring increased supply to blood storage centres.
—Director, VIMS Medical College, Bellary
GH Ernakulam, Kerala regularly coordinate with several NGOs that organize voluntary blood
donation camps. Similarly, Usilampatti District Hospital in Madurai, Tamil Nadu has been involved
in sensitising the Block Medical Officers as well as local NGOs regarding the importance of
voluntary blood donation camps. Urgent and rare group blood requirements were met through
the maintenance of a voluntary blood donor registry, in addition to circulation of requests on
WhatsApp groups. Pre-intervention, the hospital used to replace blood units issued with blood
donated by the patients’ relatives. However, post-intervention, the blood bank is mostly in
stock, and if not, a list of backup donors is readily available. Government District Headquarters
Hospital Metturdam in Salem, Tamil Nadu, provides 24×7 blood transfusion services and
supplies blood units to the nearby government hospital for elective surgeries and its storage
centre. In addition to the measures adopted in Usilampatti DH, IEC material is used creatively
to educate college students on the importance of donation and its various aspects, which also
helps in the increased outreach of information. The blood bank at Padmanabapuram District
Government Headquarters Hospital, Kanyakumari district, Tamil Nadu is well-equipped with
quality infrastructure and adequate manpower. Any newly posted staff is trained on blank bank
related operations prior to being assigned related tasks. This ensures no operational hiccups.
On average, 2–5 blood donations camps are organized in a month.
In Alibag District Hospital, Raigad district, Maharashtra, blood donation camps are planned one
to two months in advance such that the average blood stock can be maintained throughout
the year to meet every request of blood requirement.

Hospitals may have a lifetime donor programme by motivating donors to become
regular donors for lifetime, and maintain a directory of blood donors who may be
reached out at the time of emergencies.
Blood donation camps may be organized regularly and follow a fixed schedule to
enable donors to plan and schedule their blood donations.
Social media-education to encourage blood donation would increase the outreach
of the message to potential donors.
Adequate facilities for storage along with provision for blood component separation
are necessary for a blood bank to function efficiently. Ensuring availability of
transfusion services round the clock will also help the hospital to maintain a low
blood bank replacement rate.

4
Challenges and
Limitations
Challenges and Limitations
This chapter highlights the main limitations and challenges faced during the exercise, including
those during on ground data collection and validation, issues related to KPIs and HMIS data
components, and limitations in the scoring process.
4.1 ISSUES AND CHALLENGES DURING THE DATA COLLECTION

AND VALIDATION EXERCISE
NABH undertook the onsite assessment and validation of HMIS data for the KPIs for 731 district
hospitals across the country. This involved conducting assessments across different districts
simultaneously on a pan India level, including hospitals in remote and difficult areas of the
country. Some challenges that were faced during the planning and execution of the assessment
and validation exercise are discussed below.
Difficult terrains and sensitive areas

Few districts in the States/UTs of Jammu and Kashmir, Arunachal Pradesh, Himachal
Pradesh, and Meghalaya were left out of the assessment owing to their extremely
difficult terrain, while some district hospitals in Nagaland and Chhattisgarh were not
assessed as they were located in sensitive parts of the states. Therefore, of the 731
district hospitals that were identified for the assessment, onsite data validation was
completed for 707 (97%) district hospitals.
Occasional administrative issues

The unpreparedness of some hospitals in keeping the records ready led to delay in
assessments.
Obtaining appropriate records was a challenge if the staff were untrained or newly
posted.
Absence of relevant staff of the said departments made the retrieval of documents/
registers difficult.
In case of unavailability or lack of detailed records in hospitals for an indicator, the
assessor had to rely on certified statements/ declarations provided by the Chief Medical
Officer or an equivalent authority at the time of the visit.
4.2 CONCERNS WITH REGARD TO KPIs AND THEIR ASSOCIATED

HMIS DATA COMPONENTS
Specific points of concern that had arisen with respect to the KPIs and their HMIS component
are summarized below:
Since the HMIS definitions are based on IPHS 2007, the data was collected based
on IPHS 2007 guidelines, and not the updated IPHS 2012 guidelines. Therefore, this
caused some discrepancy (e.g., inclusion of non-technical posts such as plumber in
the paramedic staff in IPHS 2007).
The questionnaire recorded annual scores for the numeric indicators, whereas in
the HMIS the same data is captured monthly. The assessor was required to take an

Challenges and Limitations
aggregate score of 12 months for the reference period, which was cumbersome and
susceptible to error.
Components of the KPIs that were not captured in HMIS (e.g. total number of OPD days
in a year) or that had scope for different interpretations were not reported uniformly
across States/UTs.
Health being a state subject, there is a vast variation in designations and nomenclature
of the in service positions, due to which hospitals are unable to report all medical staff
on the HMIS portal (e.g., ‘Chief Nursing Officer’ position is present in Delhi region but
not mentioned in HMIS)
4.3 LIMITATIONS OF THE SCORING PROCESS

Despite the assessment providing a holistic picture of the quality of services offered by district
hospitals, the scores should be looked at with caution. The identification of well performing
district hospitals in this exercise is not only based on the services being provided but also
dependent on a proper data recording and reporting system.39
It is important to note that the missing indicator values and mathematically incorrect values
were assigned the worst possible indicator score (=0). This should be seen as a penalty on the
particular hospital for their inability to provide relevant data.
The original endeavour of the exercise was to assess district hospitals on the basis of a composite,
weighted score of 16 indicators (see Annexure 3). Due to significant limitations in the data, an
overall weighted average was not computed as it would not provide a complete reflection of
the service delivery of hospitals owing to significant missing data elements. Subsequent rounds
of this exercise can attempt to include more variables and compute a composite score to rank
the hospitals.
39 The data set used for the evaluation is for the period 2017-18 and not representative of the present-day scenario.

Learnings and Way Forward
5
Learnings and
Way Forward

A systematic assessment of district hospitals across the country can serve as a valuable resource
of their performance, and guide hospital managers perform better. With such a system in
place, the hospitals receiving a lower score on each individual parameters can learn from the
top performing ones. When such an assessment is undertaken annually, it will foster a sense of
healthy competition between district hospitals and provide them an opportunity to showcase
progress against individual indicators, such as health information systems, stockouts, functional
beds, among others.
5.1 KEY LEARNINGS AND OBSERVATIONS FROM THE DISTRICT

HOSPITAL PERFORMANCE ASSESSMENT
District hospitals cater to a wide spectrum of the population, including people from neighbouring
states and districts, depending on its ease of accessibility. The findings reveal that there is scope
for improvement in the quality and quantity of resources available in most district hospitals;
nevertheless, the services provided by district hospitals are indispensable for the masses.
It is encouraged that the best practices shared by top performing district hospitals be adopted
suitably by all district hospitals with the aim to serve the public in a better equipped and more
optimal manner.
Along with service delivery, maintenance of records and accurate data reporting are equally
important to assess the performance of the hospitals and analyse their outputs and outcomes.
District hospitals that had adopted digitized data reporting formats and had a dedicated staff
to monitor data not only fared better in the performance assessment but also were able to
utilize the data for internal decision-making and output improvement.
Data elements that were clearly defined or straightforward (such as the components under
core health care services and diagnostic testing services) were uniformly reported across
States/UTs, while the definition of elements such as the personnel in position (doctors, nurses,
paramedical staff) saw variations across States/UTs. It was also found that the format of the
physical records maintained by the hospitals did not always correspond their corresponding
HMIS format, thereby requiring additional measures for data collection.
This exercise highlights the importance of accurate and quality data reporting and is expected
to lead to an improvement in the quality of HMIS data. An institutional mechanism that helps
build capacity and sustain these practices would be useful. It is anticipated that this could
encourage policy makers and programme managers using HMIS data to undertake real-time
programme evaluation, course correction, and evidence-based policy formulation.
Overall, States/UTs gave very positive feedback regarding the whole validation exercise and
emphasised that it brought about awareness among district hospitals on HMIS and proper
record keeping.
5.2 ACTION POINTS FOR STAKEHOLDERS CONCERNED

Based on the results of this exercise and the process, some learnings have emerged, which
may be incorporated for an overall improvement in the health outcomes. Thereby, the following
action points have been formulated:

5.2.1 Improving data reporting in HMIS

Data reporting standards in HMIS may be enhanced through a largely improved understanding
of data definitions and an overall facility-level record maintenance.
Suggestions to the Ministry of Health and Family Welfare:

Strengthen HMIS system: HMIS should be strengthened through various means, for
example, clarification on the definitions (as it has been found that a number of hospitals
were not clear with respect to the accepted definitions of various terms), periodic
inspections (on the lines of this exercise) at the local level, and better data management
of data quality at the hospital level.
Increase regular trainings on digitisation: Frequent digital trainings/orientation of
data entry operators/officials concerned with regular assessment and reviews, besides
accountability for the quality of data entered on HMIS portal, should be undertaken.
Suggestions for States/UTs:

Increase resources to improve quality at district hospital: Adequate resources may
be provided to district hospitals towards digitization. This can be done by enabling
provision of good data network, organizing frequent training sessions, and encouraging
large-scale use of various platforms of Government of India like Mera Aspataal. National
and regional level trainings, workshops etc. may be organized to acknowledge as well
as disseminate hospitals’ best practices.
Maintain uniformity and continuity in data entry: Necessary regular posts should be
created by the State/UT to maintain continuity and uniformity in data management
work at the hospital.
Health system strengthening: After the data validation activity undertaken for this
exercise by NABH, there is now immense awareness regarding the HMIS portal, which
can be used to strengthen the quality of collection and collation of data in the district
hospitals.
Increase accountability: It is suggested that the accountability of the officer’s in-
charge of the facility for quality of data reporting should be increased and their role
clearly defined.
Suggestions for district hospitals:

Improve maintenance of records: The district hospital should maintain records
accurately and also as per the HMIS definitions. Documentation is also important for
audit and inventory management.
Encourage maximum participation: Awareness drives about the HMIS, Drugs and
Vaccine Distribution Management System, Mera Aspataal as well as the importance of
correct record keeping should be regularly undertaken.
Increase both in-person and digital trainings: District hospital staff should be
encouraged to attend trainings regularly and incorporate the learnings from the training
in their practice and day to day work to ensure quality, completeness, and continuity to

guidelines in maintaining records. The teachings of the trainings should also be passed
on to the new staff.
Encourage digitization: Heads of the hospitals should ensure that all the staff are
encouraged and adequately trained to enable digitization, so that use of Electronic
Medical Records and Hospital Management Information Systems are scaled up.
Align raw data with HMIS elements: District hospitals should focus on aligning the
raw data that they maintain as per the definition of the HMIS data elements.
5.2.2 Improving the framework of the performance assessment

exercise
Outcome-based measures of system functioning at the district level are needed to help
programme managers plan and prioritize their resources at the state and district levels. The
performance assessment of district hospitals presented in this report is the first step towards this
endeavour. Going forward, similar exercises will be repeated taking into account the challenges
and limitations faced during this initial stage with suitable measures to address them. It is
endeavoured that in the subsequent rounds, more KPIs will be included so that a weighted
average score of district hospitals is computed to generate a District Hospital Index, which
would enable ranking of all the district hospitals. To this end, the following recommendations
are proposed:
Leverage HMIS for monitoring of Sustainable Development Goals

India is committed to achieving SDGs by 2030. At present, monitoring of many health-related
indicators that measure the progress of SDGs is dependent on demographic surveys such as
the National Family Health Surveys that are conducted once every three to five years. This could
mean that by 2030, the year when the SDG goals have to be achieved, the country would have
only around two to three datasets to assess its progress. HMIS could serve as an important data
source for monitoring SDGs annually. Maintaining and assessing data on an annual basis could
support policy makers to respond with agility by planning interventions and revising policies
at a relatively shorter frequency, when required.
Refining the existing KPIs and expanding indicators to include child and
maternal health, communicable diseases, and NCDs
There is scope for refinement in the data variables of the KPIs of district hospitals such that they
are brought in parity with the HMIS definitions to allow for clear and uniform data capturing.
As this district hospital assessment exercise evolves, indicators may be refined and data reporting
processes expanded to reflect how the country is progressing on crucial aspects of health care.
Since the onset of the COVID-19 pandemic, health care resources are constantly engaged in
addressing the aftermath of the spread of the virus and its variants. The extent and quality
of response to district hospitals to the pandemic can also be included in their performance
assessment.
Further, optimum ranges for each KPI may be fixed in consultation with experts.

Assign appropriate weightage to outcome-based data

A large part of data acquisition in the public health care information system has traditionally
focused on the quality and quantity of infrastructure and the processes which the hospitals have
adopted. Many of the present variables included in the exercise, however, are proxy indicators
that reflect the health of the hospitals indirectly. As the exercise evolves, more indicators,
which directly represent the health outcomes and reflect the quality of services that are being
delivered at the public health facilities could be included.
It is hoped that the information shared in this report will be used by the States/UTs and districts
to improve their service delivery and thereby, improve performance on health outcomes. It
will also foster healthy competition and motivate district hospitals and States/UTs to take
corrective measures, where needed. On the whole, the findings of this first-ever facility-based
comprehensive exercise for measuring performance will set the foundation for more informed
policy formulation, strategy, and planning for better health outcomes.
While the performance of district hospitals presented in this report is for the financial year
2017–18, there was a setback in its timely release — this exercise being first of its kind
saw a few hiccups in data collection, validation, and analysis. Further, the onset of the
COVID-19 pandemic hammered the task of data analysis, validation, and report-writing.
Given the novelty of this exercise, its importance in assessing and improving performance
of an important element in our health care system, this delay may be overlooked. Future
reports may assess the performance against the 2017–18 baseline data. The report is
relevant, as it gives the first-ever insight into the district hospitals’ performance and will
help program managers in effective decision-making. It is hoped that subsequent rounds
of the assessment will be enhanced to incorporate additional indicators as well as improve
the methodological framework, such that the performance of district hospitals is reflected
in a holistic manner.


Annexures
ANNEXURES

Annexures
ANNEXURE 1
HEALTH MANAGEMENT INFORMATION SYSTEM
HEALTH MANAGEMENT INFORMATION SYSTEM

A government to government (G2G) web-based monitoring information system, HMIS is
implemented by the Ministry of Health & Family Welfare (MoH&FW), Government of India with
the primary goal of monitoring the National Health Mission (NHM) and other health programmes.
The information that emerges from this exercise serves as evidence and analysis, which helps
shape policy formulation and strengthens programme interventions.
In 2011, facility-based reporting was initiated in the HMIS, which was refined as an information
technology platform of in.Net and MS SQL. It has proved to be a valuable tool that grades
health facilities, identifies aspirational districts, and reviews state programme implementation
plans (PIPs), among others. It is widely used by the central/state governments to monitor and
supervise the different functions that make up the public health system.
These HMIS formats are designed to capture data on a set of indicators that are vital to track and
measure performance of health programmes. The Monthly Service Delivery formats successfully
collate data on over 300 indicators that cover the length and breadth of the health programmes
and schemes run by the Health Ministry. They take into account aspects related to reproductive
and child health, health facility services, mortality, monthly inventory, and other programmes.
The Quarterly Training formats capture data on training imparted to medical and paramedical
staff at district and state levels and other NHM components. This covers the status of health
infrastructure, trainings conducted (in various NHM components for medical, paramedical, and
other staff of PMU), and additional NRHM components.
Formats on Annual Infrastructure take into account data on manpower, equipment, cleanliness,
building, and availability of medical services such as surgery, super specialties services such
as cardiology, diagnostics, paramedical, and clinical services. Specifically, the nine categories
under which infrastructure data is collected includes services, physical infrastructure, manpower,
operation theatre, blood bank/ storage, investigative and laboratory services, capacity-building,
equipment drugs and furniture and quality control.

Annexures
ANNEXURE 2
SUMMARY OF HEALTH SYSTEMS STUDIED
1. IPHS GUIDELINES FOR DISTRICT HOSPITALS

The IPHS guide the HMIS annual infrastructure form, from which multiple indicators were directly
picked. Revised in 2012, they cover the following domains, recommended by size:
Services
Physical Infrastructure
Manpower Requirements
Equipment norms
Laboratory Services at District Hospital
Recommended Allocation of Bed Strength
Requirements of Operation Theatre
List of Drugs/Lab Reagents/Other Consumables and Disposables for District Hospitals
Capacity Building
Quality Assurance and Quality Control of Processes and Service Delivery
Statutory Compliance
Rogi Kalyan Samitis (RKS)/Hospital Management Committee (HMC)
Citizen’s Charter
2. STAR RATING SYSTEM FOR CHCS

Star Rating System of the CHCs provides a good reference as it makes use of data sources
that are readily available to us.
Categories considered
Human Resources available
Infrastructure available
Drugs and supplies
Service availability
Client orientation
Service utilization
Calculating the outcome:

HR + Infrastructure —> facility is eligible for Star Reporting and gets 1 Star; NA where
parameters are not reported or reported 0

Annexures
Where parameters have a non-zero value —> NE (Not eligible)

One star each for fulfilling criteria of delineated for other aspects
All yes/no questions
3. ACCREDITATION STANDARDS FOR HOSPITALS AND

HEALTHCARE PROVIDERS – NABH
The following key domains to measure hospital quality are assessed:
Access, Assessment and Continuity of Care (AAC)
Care of Patients (COP)
Patient Rights and Education (PRE)
Infection Control (IC)
Continuous Quality Improvement (CQI)
Responsibilities of Management (ROM)
Facilities, Management and Safety (FMS)
Community Participation and Integration (CPI)
The orientation for assessment is truly patient-centred and provides a great reference for a
vision for improving healthcare quality in India at the facility level.
4. INSTITUTE OF MEDICINE (IOM) REPORT – CROSSING THE

QUALITY CHASM
The initial motivation for the report was to counter the alarmingly high rate of preventable
medical errors in the United States. It is now referenced as a basis for measuring quality care
as the US shifts from a fee-for-service model to a value-based system —> for Affordable Care
and Patient Protection Act (ACA) 2010
Six quality aspects that are key to healthcare have been identified
Safety
Effectiveness
Timeliness
Efficiency
Personalization
Equity
5. US NEWS AND WORLD REPORT BEST HOSPITALS RANKING

The four domains for hospital ranking are structure, process, outcomes, and patient safety.
Specifically for outcomes, the following measures are considered – risk-adjusted mortality based

Annexures
on observed and expected values, and related indicators such as complications, readmissions,
patient safety, infection rate
Weighting
The weights given to each domain are as follows – 32.5% for outcomes, 30% for structure, 27.5%
for process, 10% for patient safety. Values normalized prior to weighting using the following
formula:
(Value – minimum possible) / (maximum possible – minimum possible)
6. CENTER FOR MEDICARE AND MEDICAID SERVICES (CMS) STAR

RATING – HOSPITAL QUALITY INITIATIVE
The aim was for patient’s to be able to choose hospitals based on ratings, which provides
incentive through profits gained by being patient’s choice.
The categories measured were informed by the IoM report, Agency for Healthcare Research
and Quality, National Quality Forum and The Joint Commission. A variety of data sources are
used to create The Hospital Compare profile, which consists of the following:
General Information
Survey of Patients’ Experience
Timely and effective Care
Complications
Readmissions and deaths
Use of medical imaging
Usage rate by type of diagnostic test, to gauge over-usage or potential of missing a
diagnosis; often lower percentages are better or a recommended range is prescribed
Payment and value of care
7. STUDY OF SELECTED INTERNATIONAL HEALTH SYSTEMS – UK,

TAIWAN, JAPAN, GERMANY
Great Britain is seen to be a leader in preventive medicine and sees virtually no medical
bankruptcy.
Taiwan worked with a Harvard-led committee to examine the world’s best healthcare systems
before reforming their own. The underlying goals of reform were equal access, no waiting, and
competition among providers. An excellent information technology infrastructure was used to
create the ‘smart card’ for every citizen. No medical bankruptcy is observed, but the system,
however, is very financially strained.
Japan boasts of the world’s longest life expectancy and lowest infant mortality. The system is
one of social insurance – the government picks up a tab for those too poor to pay for healthcare.
The Japanese health ministry controls the price of healthcare tightly. Despite the system being
very popular among citizens, 50% hospitals are in financial deficit.

Annexures
Germany: Sickness funds – premiums based on income to private insurers, are the main means of
healthcare funding. Health insurance continues with no change if citizens become unemployed.
The system is extremely efficient – medical providers and insurers negotiate standard prices.
Insurance plans actively compete though they are not allowed to profit.
SYSTEMS STUDIED FOR METHODOLOGY
1. Times Heath All India Multispeciality Hospitals Ranking Survey 2016

Desk Research, Factual Data Collection and a Perceptual Survey were used to choose hospitals
and identify indicators to be measured. A detailed scoring system was developed for each
parameter. After assigning scores to each parameter, raw scores were calculated. Based on
importance determined through a regression model, raw scores were weighted. The weighted
average of factual and perceptual score, with both given equal weight, yielded a final result.
2. WHO Ranking of World Health Systems

Methodologically, performance is measured by how well a country achieves the above five
goals, relative to how well it can given its resource and development level. It is acknowledged
that the overall goal attainment may not be ‘0’ even in the absence of a modern health system.
The framework is in reference to the minimum – the level of attainment that would exist even
in the absence of any health inputs.
A weighted average of the five component goals yields a conclusive result. A survey to gauge
preference of individuals in their valuation of each goal was used to reach the distribution. A
transcendental logarithmic model was used.
A linear equation is used to visualize the data, where the intercept is country-specific. Overall
efficiency is represented by [(composite)-(minimum)] / [(maximum-minimum)]
3. Times Higher Education Ranking

13 carefully calibrated performance indicators grouped into five areas – teaching, research,
citations, international outlook, industry income, each with different weights, are used.
On the rare occasions when the data are not provided, estimations are made – a low estimate
between average value of indicators and the lowest value reported i.e. the 25th percentile of
other indicators. That way, they avoid a harsh zero while being careful not to reward them for
withholding information
The standardization approach used is based on the distribution of data within a particular
indicator, and an evaluation is made on where a particular institution’s indicator sits within a
calculated cumulative probability function.
4. NBE Testing Methodology

Item response theory (IRT) is a psychometrically supported statistical model. The result is a
score that takes into account performance of the candidate as well as difficulty of the form.
The difficulty of each form may be perceived to vary. A post-equating process ensures fairness.

Annexures
Exam items are concurrently analysed, and the estimated item parameters (item difficulty and
discrimination) are put onto a common metric.
5. E
ducation Development Index – National University of Educational
Planning and Administration
Raw data is converted into a normalized form. First the Best and Worst values in an indicator
are identified. The BEST and the WORST values will depend upon the nature of a particular
indicator. The formula then used is: 1 – [best value – observed value] / [best value – worst value]
Once the Normalized Values are obtained for all the indicators across Districts/States, the
next step is to assign factor loadings and weights. Principal Component Analysis (PCA) is
used to compute the same. The objective of Principal Component analysis is to reduce the
dimensionality (number of indicators) of the data set but retain most of the original variability
in the data. The first Principal Component accounts for as much of the variability in the data
as possible, and each succeeding component accounts for as much of the remaining variability
as possible.
6. C
ounty Health Rankings and Roadmaps – Robert Wood Johnson
Foundation
Each measure within each state is standardized to the average of counties in that state. The
measures are in a number of different scales—some are percentages, some are rates, some
are averages of survey responses, or other metrics. Standardizing each of these measures
transforms them to the same metric—a mean (average) value of 0 and a standard deviation
(measure of spread) of 1. We refer to these as Z-scores where:
Z = [ (County Value)–(Average of Counties in State)] / [ (Standard Deviation of Counties in
State)]
Each Z-score is relative to the other counties in that state—not compared to an absolute
standard—and shown in the metric of standard deviations. A positive Z-score indicates a value
higher than the average of counties in that state; a negative Z-score indicates a value for that
county lower than the average of counties in that state. For most of the measures, a higher
Z-score score indicates poorer health, but for those that it doesn’t, the sign is merely reversed.
The overall scores computed are weighted composites of the Z-scores for individual measures
where the weights represent relative importance of the different measures.

Annexures
ANNEXURE 3
DEFINITIONS OF KEY PERFORMANCE INDICATORS (KPIs) FOR THE

DISTRICT HOSPITAL PERFORMANCE ASSESSMENT
Indicator categories:
A–Indicators that are largely under the control of the State
B–Indicators that are largely under the control of the district hospital
Key
Category
Sr. Performance Source of
of the Numerator Denominator
No. Indicator Information
KPI
(KPI)
Domain: Structure
1 A Number of Number of functional Population of Numerator: HMIS

functional hospital beds X 100,000 district according Infrastructure
hospital Inclusion: to Census 2011 format
beds per
1. Beds available in hospital Special Denominator:
100,000
for admissions Consideration: If Manual entry
population
Exclusion: the district has (Census of India
more than one 2011)
1. Floor Beds*
district hospital,
2. Trolley Beds* the population
3. Labour Room/ OT denominator will
Tables be estimated in
4. Observation Beds in the same ration as
Emergency/OT/Labour ratio of number of
Room* beds of particular
DH to DH level
*To be captured to the beds
extent possible
2.1 A Ratio of Number of doctors in IPHS norm for Numerator: HMIS

doctors in position the respective Infrastructure
position to category hospitals format
Inclusion: MBBS/BDS/
IPHS norms 500 beds – 68 Denominator:
AYUSH
400 beds – 58 Pre-entered value
Specialist
(IPHS guidelines
300 beds – 50 for district
200 beds – 34 hospitals, 2012,
p. 37)
100 beds – 29

Annexures
Key
Category
KPI
(KPI)
2.2 A Ratio of staff Number of staff nurses in IPHS norm for Numerator: HMIS
nurses in position the respective Infrastructure
position to Exclusion: ANM category hospitals format
IPHS norm 500 beds – 225 Denominator:
400 beds – 180 Pre-entered value
(IPHS guidelines
300 beds – 135 for district hospi-
200 beds – 90 tals, 2012, p. 37)
100 beds – 45
2.3 A Ratio of Number of paramedical IPHS norm for Numerator: HMIS

paramedical staff in position the respective Infrastructure
staff in Inclusion: All categories category hospitals format
position to included in IPHS 500 beds – 100 Denominator:
IPHS norm Pre-entered value
400 beds – 81
(IPHS guidelines
300 beds – 66 for district
200 beds – 42 hospitals, 2012,
p. 37)
100 beds – 31
3 B Availability Proportion of the following 14 Numerator: For

of support support services available item (i) – Manual
services from the total: entry
i. Hospital information For items (ii) to
system (At least OPD, (x) – IPHS
IPD and Pharmacy
Infrastructure
Module)
format
ii. Sterilization and
Denominator:
Disinfection – CSSD
Pre-entered value
(Central Sterile Supply
(based on IPHS
Department)
guidelines for
iii. Blood Bank district hospitals,
2012, p. 6)
iv. Waste management
including biomedical
waste
v. Medico-legal / post-
mortem
vi. Dietary services for
patient
vii. Electric supply backup
viii. Pharmacy
ix. Water supply
(plumbing)
x. Refrigeration

Annexures
Key
Category
KPI
(KPI)
4 A Availability Proportion of specialties 14 Numerator: HMIS

of core from the list that are Infrastructure
health care functional format
services
i. General Medicine Denominator:
Pre-entered value
ii. General Surgery
(based on IPHS
iii. Obstetrics and guidelines for
Gynaecology district hospitals,
2012, p. 6)
iv. Paediatrics, including
neonatology [as
required for a Level II
SNCU]
v. Emergency (Accident
and other emergency)
(Casualty 24x7 basis)
vi. Critical Care (ICU)
vii. Anaesthesia
viii. Ophthalmology
ix. ENT
x. Dermatology and
Venereology (Skin and
VD) RTI/STI
xi. Orthopaedics
xii. Dental Care
xiii. Public Health Unit
(may be collocated)
xiv. Radiology
5 A Availability Number of diagnostic 14 Numerator: HMIS

of diagnostic services available Infrastructure
testing format
i. Urine analysis
services
Denominator:
ii. Stool analysis
Pre-entered value
iii. PAP Smear (based on IPHS
guidelines for
iv. Sputum
district hospitals,
v. Haematology 2012, p. 58–60)
vi. Microbiology
vii. Serology
viii. Biochemistry
ix. Cardiac Investigation
x. Ophthalmology
xi. ENT

Annexures
Key
Category
KPI
(KPI)
xii. Radiology
xiii. Endoscopy
xiv. Physiology (Pulmonary
Function Test)
Inclusion:
In-house lab
Outsourced laboratories
Exclusion:
Test done through referral
laboratories
Domain: Output
6 B Bed Total number of inpatient Total Functional Numerator:

occupancy bed days added for a year Beds X 365 Statement
rate X 100 from medical
Exclusion:
superintendent
Exclusion:
1. Floor Beds office (manual
Day Care Patients; Newborn entry)
2. Trolley Beds
admitted with mother in
Denominator:
maternity ward 3. Labour Room/
HMIS
OT Tables
Infrastructure
4. Observation format
Beds in
Emergency/OT/
Labour Room
7 B C-section Number of C-section Total number of Numerator &

rate deliveries performed in the deliveries in the Denominator:
year X 100 year (Normal + HMIS service
Assisted Deliveries delivery format
+ C Section)
8 B Surgical Total number of major Total number Numerator: OT

productivity surgeries in a year of surgeons register
index excluding
Exclusion: Obstetrics Denominator:
& Gynaecology, Obstetric/ HMIS
Ophthalmology surgeries Gynaecological Infrastructure
surgeon; format
Ophthalmologist;
Dental Surgeon

Annexures
Key
Category
KPI
(KPI)
9 B OPD per Total number of OPD Number of Numerator: HMIS

doctor patients in a year positioned service delivery
doctors X OPD format
days in that year
Denominator:
HMIS
Infrastructure
format +
Statement
from medical
superintendent
office (manual
entry)
10 B Blood bank Total number of blood units Total number of Numerator &
replacement issued on replacement in blood units issued Denominator:
rate the year X 100 in year Blood bank issue
Inclusion: register
Voluntary
donation;
Replacement
Note:
The original endeavour of the exercise was to assess district hospitals on the basis of a composite,
weighted score of 16 indicators. In order to compute the index, the hospital raw scores of each
KPI, which were not in uniform units, were to be scaled as per the formulae below. A composite
index was to be calculated by taking the average of the scaled values, a higher index indicating
a better hospital.
Scaling formula
X – Minimum value
Scaled value (positive indicator*) =
Maximum value – Minimum value
Minimum value
Scaled value (negative indicator*) =
Maximum value – Minimum value
* Three indicators (stockout rate of essential drugs, blood bank replacement rate, post-surgical infection rate)
shortlisted for the assessment had negative valence, while the rest of the KPIs had positive valence.
Due to significant limitations in the data, 6 KPIs were excluded from the assessment. The
excluded KPIs are listed in the table below, accompanied with their definitions. Due to this
exclusion, the composite index of hospitals was disregarded as it would not provide a complete
reflection of the service delivery of hospitals. Alternatively, the hospitals were assessed for their
performance on individual KPIs. However, in order to shortlist the top performing hospitals, in
the case of a tie in their raw score, the composite score of the hospital (average of the scaled
values of the above-listed 10 KPIs) was considered, and the district hospital with a higher
composite score was viewed as the better performing hospital.

Annexures
Key
Category
Sr. No. Performance Numerator Denominator Source of Information
of the KPI
Indicator (KPI)
Domain: Process
1 B Kayakalp Total obtained Total no. of Online where

score score (on peer Checkpoint X 2 possible (Kaykalp
assessment) X 100 score generated
using Kayakalp
assessment through
peer review process
validated by district
Kayakalp committee)
2 B Quality Score Total obtained Total no. of Online where

score X 100 Checkpoint X 2 possible (QA score
generated using
NQAS assessment
tool for district
hospital)
Domain: Output and Outcome
3 B Number of Number of lab Number of lab Numerator:

laboratory tests conducted technicians available Laboratory register
tests per in-house
Inclusion: Test Denominator:
technician
done in in-house Inclusion: Lab Statement
laboratory technician available from Medical
in-house, including Superintendent
Exclusion: Lab
lab technician on Laboratory
test done bed
deputed under Technician in Position
side/ Point of
disease control (taking into account
care lab test done
program such as exclusion criteria)
in outsourced
RNTCP, NVBDCP &
laboratory
NACP.
Exclusion: Lab
technician in
outsourced
laboratory; lab
attendants
4 B Stock-out Total no. of Total number of Numerator and

rate of stockout days in essential drugs X Denominator:
essential the year X 100 365 Drug and Vaccine
drugs Distribution
Stock out days:
Management System
Total no. of stock
(DVDMS)
outs occurred daily
added for the year

Annexures
Key
Category
Sr. No. Performance Numerator Denominator Source of Information
of the KPI
Indicator (KPI)
5 B Post-surgical No. of surgical Total No. of clean Numerator: OT septic

infection rate cases developed surgeries performed register
post- operative in the year
Denominator: OT
surgical site
Register
infection during
the year
Surgical site
infection – Any
purulent discharge
around the wound
or the insertion
site of the drain, or
spreading cellulitis
from the wound
6 B Patient Feedback score Total no. of patients As is calculated.

satisfaction obtained by interacted X Where the DH has
score patient satisfaction maximum score no patient feedback
survey X 100 system, score will be
0.

Annexures
ANNEXURE 4
STATE/UT-WISE TOP SCORING DISTRICT HOSPITAL FOR EACH KEY

PERFORMANCE INDICATOR (KPI)
1. Number of 2.3 Number of

Indicator 2.1 Number of 2.2 Number of
functional beds paramedicals in
doctors in position nurses in position
per 100,000 position to IPHS
State/UT to IPHS norms to IPHS norms
population norms
Andaman and BJR Hospital, G.B.Pant Hospital, G.B.Pant Hospital, G.B.Pant Hospital,
Nicobar Islands Nicobar South Andaman South Andaman South Andaman
King George King George King George King George

Andhra Pradesh Hospital TH, Hospital TH, Hospital TH, Hospital TH,
Vishakapatnam Vishakapatnam Vishakapatnam Vishakapatnam
GH Pasighat, East Tomo Riba Institute Tomo Riba Institute Tomo Riba
Arunachal Siang of Medical Science of Medical Science Institute of
Pradesh & Hospital, Papum & Hospital, Papum Medical Science
Pare Pare & Hospital
Haflong Civil Diphu Civil LGB Civil 200 Bedded

Assam Hospital, Dima Hospital, Karbi Hospital, Tinsukia Civil Hospital,
Hasao Anglong Goalpara
Sadar Hospital Sadar Hospital Sadar Hospital Sadar Hospital

Bihar Saharsa, Saharsa Jehanabad, Samastipur, Nawada, Nawada
Jehanabad Samastipur
Narayanpur DH, Raipur DH, Raipur, Raipur DH, Dantewada,

Chhattisgarh Narayanpur, Chhattisgarh Raipur, Dantewada,
Chhattisgarh Chhattisgarh Chhattisgarh
Government Government Government Government

Daman and Diu Hospital Daman, Hospital Daman, Hospital Daman, Hospital Daman,
Daman Daman Daman Daman
Hedgewar Lal Bahadur Shastri Deendayal Deendayal

Hospital, Hospital, East Delhi Upadhyay Upadhyay
Delhi
Shahdara Hospital, West Hospital, West
Delhi Delhi
South Goa North Goa District North Goa North Goa

Goa District Hospital, Hospital, North Goa District Hospital, District Hospital,
South Goa North Goa North Goa
General Hospital General Hospital General Hospital General Hospital

Gujarat
Dang, The Dangs Dahod, Dahod Vyara, Tapi Dang, The Dangs
Civil Hospital, Civil Hospital, LNJP Civil Civil Hospital,

Haryana Panchkula Ambala Hospital, Rohtak
Kurukshetra
Note: As the UTs of Chandigarh, Dadra and Nagar Haveli, and Lakshadweep had only one district hospital
participating in the assessment, these UTs are not included in this table.
Dadra & Nagar Haveli and Daman & Diu are regarded as separate UTs in this assessment

Annexures

population norms
Himachal Bilaspur RH, Nahan RH, Sirmaur Nahan RH, Bilaspur RH,
Pradesh Bilaspur Sirmaur Bilaspur
Jammu and DH Doda, Doda DH Anantnag, DH Handwara, DH Kargil, Kargil

Kashmir Anantnag Kupwara
Hazaribagh Ranchi Sadar Ranchi Sadar Purbi Singhbhum

Jharkhand Sadar Hospital, Hospital, Ranchi Hospital, Ranchi Sadar Hospital,
Hazaribagh Purbi Singhbhum
Dharwad DH Victoria Hospital, Belgaum DH, Shimoga DH,

Karnataka
FRU, Dharwad Bangalore Urban Belgaum Shimoga
W&C Hospital GH Ernakulam, GH Ernakulam, GH Ernakulam,

Kerala Thiruvananthapuram, Ernakulam Ernakulam Ernakulam
Thiruvananthapuram
Ladakh Kargil DH, Leh Kargil DH, Kargil Kargil DH, Kargil Kargil DH, Kargil
DH Datia, Datia DH Gwalior, Gwalior DH Rewa, Rewa DH Tikamgarh,

Madhya Pradesh
Tikamgarh
DH Bhandara, DH Hingoli, Hingoli DH Hingoli, District Hospital

Maharashtra
Bhandara Hingoli Jalna, Jalna
Churachandpur Churachandpur Thoubal District Churachandpur

Manipur District Hospital, District Hospital, Hospital, Thoubal District Hospital,
Churachandpur Churachandpur Churachandpur
Ganesh Das Tura Civil Hospital, Tura Maternity Nongpoh DH,

Hospital, East West Garo Hills and Child Ri Bhoi
Meghalaya
Khasi Hills Hospital, West
Garo Hills
Lunglei DH, Aizawl Civil Aizawl Civil Aizawl Civil

Mizoram Lunglei Hospital, Aizawl Hospital, Aizawl Hospital, Aizawl
West West West
Ongpangkong Dimapur DH, Dimapur DH, Ongpangkong

Nagaland
DH, Mokokchung Dimapur Dimapur DH, Mokokchung
Subarnapur, Balangir DH, Rayagada DH, Phulbani DH,

Odisha
Sonapur Balangir Rayagada Kandhamal
Govt. General RGGW & CH, Govt. General Govt. General

Puducherry
Hospital, Mahe Pondicherry Hospital, Yanam Hospital, Karaikal
Nawanshahar DH, Bathinda DH, Amritsar DH, Mansa DH, Mansa

Punjab
Nawanshahr Bathinda Amritsar
District Hospital B.D.K. Hospital District Sahadat Govt Hospitls

Rajasthan Chittaurgarh, Jhunjhunun, Hospital Tonk, Sriganganagar,
Chittaurgarh Jhunjhunun Tonk Ganganagar
Mangan Hospital, Namchi District District Hospital Singtam Hospital,

Sikkim North Sikkim Hospital, South Gyalshing, West East Sikkim
Sikkim Sikkim

Annexures

population norms
Perambalur DH, Kilpauk Hospital, Kilpauk Hospital, Kilpauk Hospital,

Tamil Nadu
Perambalur Chennai Chennai Chennai
DH Sangareddy, DH Khammam, Tandur DH, Kingkoti DH,

Telangana
Sangareddy Khammam Vikarabad Hyderabad
District Hospital District Hospital District Hospital District Hospital

Tripura Unakoti District, Gomati District, North Tripura, South, South
Unakoti Gomati North Tripura Tripura
Rani Laxmi Lokbandhu Mahatma Jyotiba Combined DH,

Bai Combined Raj Narain DH, Phule DH, Kannauj
Uttar Pradesh
Hospital, Lucknow Ambedkar Nagar
Lucknow
Shyam Lal Shah B D Pandey District DH Bauradi, Tehri DH Bauradi, Tehri

Uttarakhand DH, Bageshwar Male Hospital, Garhwal Garhwal
Pithoragarh
Jhargram DH & M. R. Bangur DH & M. R. Bangur DH & Tamluk District

West Bengal SSH, Jhargram SSH, South Twenty SSH, South Twenty Hospital, Purba
Four Parganas Four Parganas Medinipur
Indicator
3. Support 4. Core healthcare 5. Diagnostic 6. Bed occupancy
services services testing services rate
State/UT
BJR Hospital, G.B.Pant Hospital, Dr. R.P.Hospital, G.B.Pant Hospital,

Andaman and
Nicobar South Andaman North and Middle South Andaman
Nicobar Islands
Andaman
Govt.Maternity RIMS Srikakulam King George GGH Anantapur,

Andhra Pradesh Hospl.TH, TH, Srikakulam Hospital TH, Anantapur
Chittoor Vishakapatnam
DH Roing, Lower Tomo Riba Institute Tomo Riba Tomo Riba

Dibang Valley of Medical Science Institute of Institute of
Arunachal
& Hospital, Papum Medical Science & Medical Science
Pradesh
Pare Hospital, Papum & Hospital,
Pare Papum Pare
Barpeta Civil Sivasagar Civil 200 Bedded North Lakhimpur

Hospital Hospital, Sibsagar Civil Hospital, Civil Hospital,
Assam
Kalgachia, Goalpara Lakhimpur
Barpeta

Sitamarhi, Motihari Purbi Purnia, Purnia Hajipur Vaishali,
Bihar
Sitamarhi Champaran, Vaishali
East Champaran
Raipur DH, Indira Gandhi DH Indira Gandhi DH Dantewada DH,

Chhattisgarh
Raipur Korba, Korba Korba, Korba Dantewada

Annexures
Indicator
State/UT

Sanjay Gandhi Sanjay Gandhi Pt. Madan Mohan Guru Govind

Memorial Memorial Hospital Malviya Hospital, Singh Govt
Delhi Hospital Mangolpuri, North South Delhi Hospital, West
Mangolpuri, West Delhi Delhi
North West Delhi
North Goa South Goa District North Goa North Goa

Goa District Hospital, Hospital, South Goa District Hospital, District Hospital,
North Goa North Goa North Goa
General Hospital General Hospital General Hospital PK General

Gujarat Mehsana, Vyara,Tapi Dahod, Dahod Hospital, Rajkot
Mahesana
Civil Hospital, Civil Hospital, Civil Hospital, LNJP Civil

Haryana Rohtak Rohtak Panchkula Hospital,
Kurukshetra
Himachal DDU ZH, Shimla Nahan RH, Sirmaur Mandi ZH, Mandi Kullu RH, Kullu
Pradesh
Jammu and DH Baramula, District Hospital DH Baramula DH Kulgam,

Kashmir Baramula JNLM, Srinagar Kulgam
Kodrma Sadar Ranchi Sadar Jamtara Sadar Lohardaga

Jharkhand Hospital, Hospital, Ranchi Hospital, Jamtara Sadar Hospital,
Kodarma Lohardaga
Shimoga DH, Shimoga DH, Shimoga DH, Gadag DH FRU,

Karnataka
Shimoga Shimoga Shimoga Gadag
GH Ernakulam, GH Ernakulam, GH Thrissur, DH

Kerala Ernakulam Ernakulam Thrissur Mananthavady,
Wayanad
Ladakh Leh DH, Leh Kargil DH, Kargil Leh DH, Leh Kargil DH, Kargil
DH Satna, Satna DH Satna, Satna DH Sehore, DH Dhar, Dhar

Madhya Pradesh
Sehore
District Hospital District Hospital District Hospital Women Hospital

Maharashtra Alibag, Raigarh Nashik, Nashik Gadchiroli, Parbhani,
Gadchiroli Parbhani
Thoubal District Thoubal District Bishnupur Churachandpur

Manipur Hospital, Thoubal Hospital, Thoubal District Hospital, District Hospital,
Bishnupur Churachandpur

Annexures
Indicator
State/UT
Ganesh Das Jowai Civil Hospital, Shillong Civil Tura Maternity

Hospital, East West Jaintia Hills Hospital, East and Child
Meghalaya
Khasi Hills Khasi Hills Hospital, West
Garo Hills
Aizawl Civil Aizawl Civil Aizawl Civil Serchhip DH,

Mizoram Hospital, Aizawl Hospital, Aizawl Hospital, Aizawl Serchhip
West West West
Ongpangkong Ongpangkong DH, Ongpangkong Ongpangkong

Nagaland
DH, Mokokchung Mokokchung DH, Mokokchung DH, Mokokchung
DH Balangir, Capital Hospital, Capital Hospital, DH Baripada,

Odisha
Balangir Khordha Khordha Mayurbhanj
Govt. General Govt. General Govt. General RGGW & CH,

Puducherry
Hospital, Karaikal Hospital, Karaikal Hospital, Karaikal Pondicherry
Amritsar DH, Jalandhar DH, Ludhiana DH, Gurdaspur DH,

Punjab
Amritsar Jalandhar Ludhiana Gurdaspur
Govt Hospitls Govt Hospitls M G Hospital District Sahadat

Rajasthan Sriganganagar, Sriganganagar, Bhilwara, Bhilwara Hospital Tonk,
Ganganagar Ganganagar Tonk
Namchi District Namchi District Singtam DH, East Namchi District

Sikkim Hospital, South Hospital, South Sikkim Hospital, South
Sikkim Sikkim Sikkim
Dindigul DH, Kilpauk Hospital, Kilpauk Hospital, Krishnagiri DH,

Tamil Nadu
Dindigul Chennai Chennai Krishnagiri
DH Khammam, DH Khammam, Karimnagar DH, DH Khammam,

Telangana
Khammam Khammam Karim Nagar Khammam
District Hospital District Hospital District Hospital District Hospital

Tripura Gomati District, Gomati District, Gomati District, Gomati District,
Gomati Gomati Gomati Gomati
Ram Manohar Ram Manohar Shyama Prasad District Female

Uttar Pradesh Lohiya DH, Lohiya DH, Mukherjee DH, Hospital, Mainpuri
Lucknow Lucknow Lucknow
J.L.N. District Shyam Lal Shah B.D.Pandey Male H G Pant District

Uttarakhand Hospital, Udham DH, Bageshwar Hospital, Nainital Female Hospital,
Singh Nagar Pithoragarh
Tamluk District M. R. Bangur DH & M. R. Bangur DH Alipurduar

Hospital, Purba SSH, South Twenty & SSH, South District Hospital,
West Bengal
Medinipur Four Parganas Twenty Four Alipurduar
Parganas

Annexures
10. Bloodbank
Indicator 7. C-section rate 8. Surgical
9. OPD per Replacement Rate
(Hospital with max. Productivity
Doctor (Hospital with min.
State/UT value) Index
value)
Andaman and G.B.Pant Hospital, G.B.Pant Hospital, G.B.Pant Hospital, BJR Hospital,
Nicobar Islands South Andaman South Andaman South Andaman Nicobar
Andhra DH Machilipatnam, DH Proddutur, DH Tenali, Guntur RIMS Ongole TH,

Pradesh Krishna Cuddapah Prakasam
Tomo Riba Institute Tomo Riba DH Roing, Lower General Hospital

Arunachal of Medical Science Institute of Medical Dibang Valley Aalo, West Siang
Pradesh & Hospital, Papum Science & Hospital,
Pare Papum Pare
LGB Civil Hospital, Dhemaji Civil Mangaldai Civil TRB Civil

Assam Tinsukia Hospital, Dhemaji Hospital, Darrang Hospital, Kamrup
R

Motihari Purbi Saharsa, Saharsa Jamui, Jamui Khagaria,
Bihar
Champaran, East Khagaria
Champaran
Bilaspur DH, DH Baloda Bazar, DH Baloda Bazar, Dhamtari DH,

Chhattisgarh
Bilaspur Baloda Bazar Baloda Bazar Dhamtari

Hedgewar Hospital, Sanjay Gandhi Deep Chand Kasturba Hospital,

Shahdara Delhi Memorial Hospital Bandhu Hospital, Central Delhi
Delhi
Mangolpuri, North North West Delhi
West Delhi
South Goa District North Goa District South Goa South Goa
Goa Hospital, South Goa Hospital, North District Hospital, District Hospital,
Goa South Goa South Goa
General Hospital S.S.Hospital Petlad, Botad, Botad General Hospital

Gujarat
Mehsana, Mahesana Anand Vyara,Tapi
Civil Hospital, Civil Hospital, Civil Hospital, Civil Hospital,

Haryana
Panchkula Mahendragarh Bhiwani Panchkula
Himachal Una RH, Una Mandi ZH, Mandi Chamba RH MCH Hamirpur RH,
Pradesh Centre, Chamba Hamirpur
Jammu and District Hospital DH Reasi, Reasi DH Shopain, DH Bandipora,

Kashmir JNLM, Srinagar Shopian Bandipora
Ranchi Sadar Garhwa Sadar Ranchi Sadar Jamtara Sadar

Jharkhand
Hospital, Ranchi Hospital, Garhwa Hospital, Ranchi Hospital, Jamtara
Bijapur DH FRU, Chikmagalur DH Chikmagalur Belgaum DH,

Karnataka Bijapur FRU, Chikmagalur DH FRU, Belgaum
Chikmagalur

Annexures
10. Bloodbank
value)
DH Aluva, DH Kollam, Kollam DH Tirur, GH Ernakulam,

Kerala
Ernakulam Malappuram Ernakulam
Ladakh Leh DH, Leh Leh DH, Leh Leh DH, Leh Kargil DH, Kargil
Madhya DH Balaghat, DH Gwalior, DH Bhind, Bhind DH Mandsaur,

Pradesh Balaghat Gwalior Mandsaur
Sindhudurg DH, Sindhudurg DH, District Hospital Lt Karntisigh

Sindhudurg Sindhudurg Jalgaon, Jalgaon Nana Patil Civil
Maharashtra
Hospital Satara,
Satara
Thoubal District Churachandpur Thoubal District Bishnupur

Manipur Hospital, Thoubal District Hospital, Hospital, Thoubal District Hospital,
Churachandpur Bishnupur
Ganesh Das Shillong Civil Mairang DH, Tura Civil

Meghalaya Hospital, East Khasi Hospital, East West Khasi Hills Hospital, West
Hills Khasi Hills Garo Hills
Lunglei DH, Aizawl Civil Aizawl Civil Mamit DH, Mamit

Mizoram Lunglei Hospital, Aizawl Hospital, Aizawl
West West
Ongpangkong DH, District Hospital, Ongpangkong Wokha DH, Woha

Nagaland
Mokokchung Dimapur DH, Mokokchung
DH Paralakhemundi, Capital Hospital, DH Nayagarh, DH Baripada,

Odisha
Gajapati Khordha Nayagarh Mayurbhanj
Govt. General Govt. General Govt. General RGGW & CH,

Puducherry
Hospital, Karaikal Hospital, Karaikal Hospital, Mahe Pondicherry
Sangrur DH, Sangrur DH, Tarn Taran DH, Sangrur DH,

Punjab
Sangrur Sangrur Tarn Taran Sangrur
District Hospital District Hospital A K Hospital A K Hospital

Rajasthan Banswara, Barmar, Barmer Beawar Ajmer, Beawar Ajmer,
Banswara Ajmer Ajmer
Namchi District Namchi District Namchi District Singtam DH, East

Sikkim Hospital, South Hospital, South Hospital, South Sikkim
Sikkim Sikkim Sikkim
Padhmanamapuram Tenkasi DH, Walajapet, DH Thiruvallur DH,

Tamil Nadu
DH, Kanniyakumari Tirunelveli Vellore Thiruvallur
Karimnagar DH, Karimnagar DH, Tandur DH, Nalgonda DH,

Telangana
Karim Nagar Karim Nagar Vikarabad Nalgonda
District Hospital District Hospital Khowai District District Hospital

Tripura Gomati District, Unakoti District, Hospital, Khowai Gomati District,
Gomati Unakoti Gomati

Annexures
10. Bloodbank
value)
Lokbandhu Tej Bahadur Sapru District Women DH Male Agra,

Uttar Pradesh Raj Narain DH, Hospital, Prayagraj Hospital, Agra
Lucknow Maunathbhanjan
H G Pant District District Hospital, J.L.N. District B.D.Pandey Male

Uttarakhand Female Hospital, Uttarkashi Hospital, Udham Hospital, Nainital
Pithoragarh Singh Nagar
M. R. Bangur DH & M. R. Bangur DH Barasat DH, Imambara District

SSH, South Twenty & SSH, South North Twenty Hospital, Hugli
West Bengal
Four Parganas Twenty Four Four Parganas
Parganas

Annexures
ANNEXURE 5
GRAPHS ILLUSTRATING THE STATE/UT-WISE AVERAGE RAW

SCORE OF EACH KPI FOR EACH HOSPITAL CATEGORY (SMALL,
MID-SIZED, AND LARGE)
KPI 1: NUMBER OF FUNCTIONAL BEDS PER 100,000 POPULATION
294
199
114 102
96
78 70
62 57
49 44
33 30 24 24 23 21
20 19 17 17 17 16 15 15 13 12 11 10 9 9 8 5 3
Nagaland
Odisha
India
Punjab
Haryana
Bihar
Telangana
A & N Islands
Ladakh
Daman & Diu
Tripura
Karnataka
West Bengal
Tamil Nadu
Mizoram
Meghalaya
Assam
Maharashtra
Uttar Pradesh
Kerala
Puducherry
Arunachal Pradesh
Manipur
Uttarakhand
Jammu & Kashmir
Gujarat
Sikkim
Chhattisgarh
Delhi
Himachal Pradesh
Rajasthan
Madhya Pradesh
Jharkhand
Lakshadweep
Figure A1-1: Average number of beds in small district hospitals (up to 200 beds) for every
1 lakh population by State/UT
187
144
70
46
36 32 29 28 23 22 21 20 20 18 17 16 15 14 14 13 13 12 11 8
Ladakh
Arunachal Pradesh
Mizoram
Himachal Pradesh
Haryana
Goa
Karnataka
Chhattisgarh
India
Assam
Kerala
Madhya Pradesh
Gujarat
Odisha
Rajasthan
Delhi
Telangana
Uttar Pradesh
Tamil Nadu
West Bengal
Andhra Pradesh
Maharashtra
Bihar
Punjab
Figure A1-2: Average number of beds in mid-sized district hospitals (201–300 beds) for
every 1 lakh population by State/UT
200
150
119
92 89
57
38 33 30 29
28 28 25 23 22 21 21 21 20 19 16 13 12 12
A & N Islands
Puducherry
Meghalaya
Delhi
Chandigarh
Karnataka
India
Gujarat
Uttar Pradesh
Tamil Nadu
Madhya Pradesh
Kerala
Assam
Rajasthan
Punjab
Andhra Pradesh
Odisha
West Bengal
Jharkhand
Maharashtra
Telangana
Chhattisgarh
Bihar
Figure A1-3: Average number of beds in large district hospitals (more than 300 beds) for
every 1 lakh population by State/UT

104
Annexures
KPI 2: R
1
Delhi 1.99 Delhi 2.42
Delhi 3.36
Puducherry 1.36 Haryana 1.46

Tripura 2.87
Madhya Pradesh 1.25 West Bengal 1.21
Haryana 2.81
West Bengal 0.98 Jammu & Kashmir 1.08
Punjab 2.71
Haryana 0.98 Manipur 1.01
Manipur 2.62
Maharashtra 0.97 Puducherry 1.00
West Bengal 2.10
Tripura 0.96 Madhya Pradesh 0.93
Odisha 2.05

Odisha 0.89 Odisha 0.90
Arunachal Pradesh 2.02
Puducherry 2.00 Punjab 0.88 Punjab 0.87
Mizoram 1.87 Telangana 0.82 Maharashtra 0.80
Sikkim 1.80 Meghalaya 0.80 Assam 0.77
Nagaland 1.77 Bihar 0.75 Sikkim 0.77
India 1.52 Manipur 0.70 Lakshadweep 0.72
Uttar Pradesh 1.45 Chhattisgarh 0.67 India 0.70
Madhya Pradesh 1.41 Gujarat 0.63 Chhattisgarh 0.70
For hospitals with up to 100 beds:
A & N Islands 1.39 India 0.61 Telangana 0.69

Bihar 1.34 Karnataka 0.60 Bihar 0.62
Chhattisgarh 1.31 Assam 0.58 Arunachal Pradesh 0.58
Jammu & Kashmir 1.25 Sikkim 0.53 Tripura 0.57
Karnataka 1.22 Uttar Pradesh 0.49 Jharkhand 0.57
Jharkhand 1.18 Arunachal Pradesh 0.47 Meghalaya 0.56
Maharashtra 1.02 Lakshadweep 0.47 Uttar Pradesh 0.55
Assam 1.00 Daman & Diu 0.44 Karnataka 0.49
Lakshadweep 0.97 Mizoram 0.40 Nagaland 0.48
Uttarakhand 0.93 Uttarakhand 0.38 Uttarakhand 0.47
Meghalaya 0.65 A & N Islands 0.36 Daman & Diu 0.45
Gujarat 0.60 Nagaland 0.33 A & N Islands 0.41
Himachal Pradesh 0.55
STAFF IN PROPORTION TO IPHS NORMS
Jammu & Kashmir 0.32 Mizoram 0.41

Telangana 0.39 Jharkhand 0.23 Gujarat 0.34
position to the IPHS requirement of 45 nurses

position to the IPHS requirement of 29 doctors
Daman & Diu 0.29

Himachal Pradesh 0.13 Himachal Pradesh 0.24
Meets
Meets
Meets
requirement
beds in position to the IPHS requirement of 31 paramedical staff

requirement
requirement
Figure A2.1-2: State/UT-wise average ratio of nurses in hospitals with up to 100 beds in
Figure A2.1-1: State/UT-wise average ratio of doctors in hospitals with up to 100 beds in
Figure A2.1-3: State/UT-wise average ratio of paramedical staff in hospitals with up to 100
ATIO OF DOCTORS, STAFF NURSES, AND PARAMEDICAL
1
1
1
Manipur 6.69 Delhi 2.57
Ladakh 4.74 Manipur 2.12
Mizoram 3.55
Delhi 1.20
Haryana 1.51
Maharashtra 1.02
Arunachal Pradesh 3.21 Arunachal Pradesh 1.44
Rajasthan 0.83
Telangana 3.21 Jammu & Kashmir 1.31
Puducherry 0.82
Delhi 3.07 Rajasthan 1.22
Madhya Pradesh 0.81
Nagaland 2.58 Mizoram 0.72 Maharashtra 1.08
Puducherry 2.50 Ladakh 0.69 Meghalaya 1.07
Haryana 2.38 Punjab 0.68 Ladakh 1.00
Sikkim 2.29 Daman & Diu 0.64 Punjab 0.99
Punjab 2.19 Haryana 0.63 Kerala 0.97
Madhya Pradesh 2.19 Tripura 0.62 India 0.92
Tripura 2.10 Meghalaya 0.58
Mizoram 0.91
Jammu & Kashmir 2.07 Assam 0.58
Sikkim 0.91
Maharashtra 1.81 Manipur 0.57
Chhattisgarh 0.86
For hospitals with 101-200 beds:
India 0.54
Rajasthan 1.68 Assam 0.85
Nagaland 0.53
India 1.67 Odisha 0.83
Chhattisgarh 0.53
Odisha 1.50 Karnataka 0.82
Gujarat 0.51
Assam 1.49
Telangana 0.50 Jharkhand 0.82
Uttar Pradesh 1.41 Odisha 0.48 Madhya Pradesh 0.82
Chhattisgarh 1.35 Jharkhand 0.47 Nagaland 0.79
Jharkhand 1.32 Karnataka 0.46 Daman & Diu 0.79
Himachal Pradesh 1.20 Tamil Nadu 0.44 Telangana 0.76
Karnataka 1.09 Kerala 0.41
Tripura 0.75
Bihar 1.05 Arunachal Pradesh 0.40
Uttar Pradesh 0.72
Gujarat 1.02 Himachal Pradesh 0.40
Bihar 0.69
Tamil Nadu 1.02 Bihar 0.38
Uttar Pradesh 0.35 Tamil Nadu 0.65
A & N Islands 0.98
Jammu & Kashmir 0.32 Himachal Pradesh 0.59
Meghalaya 0.87
Sikkim 0.29 Gujarat 0.56
Kerala 0.75
A & N Islands 0.28 Puducherry 0.56

Daman & Diu 0.50

Uttarakhand 0.23 Uttarakhand 0.51
Uttarakhand 0.48
A & N Islands 0.24
Meets
Meets
Meets
beds in position to the IPHS requirement of 42 paramedical staff

requirement
requirement
requirement
Figure A2.2-3: State/UT-wise average ratio of paramedical staff in hospitals with up to 200

Annexures
105
106
Annexures
1
1
1
Mizoram 5.95 Mizoram 1.32 Arunachal Pradesh 2.10

Arunachal Pradesh 3.35 Delhi 1.31 Delhi 1.75
Ladakh 2.88 Goa 1.07 Mizoram 1.66
Goa 2.63 Haryana 1.00 Goa 1.40
Delhi 2.23 Arunachal Pradesh 0.92 Odisha 1.28
Haryana 2.05 Maharashtra 0.89

West Bengal 1.13
Madhya Pradesh 1.96 Madhya Pradesh 0.81 Haryana 0.93
Maharashtra 1.91 West Bengal 0.79 Punjab 0.92
Telangana 1.68 Rajasthan 0.64 Rajasthan 0.88
West Bengal 1.67 Assam 0.59 Maharashtra 0.88
Chhattisgarh 1.41 India 0.58 Andhra Pradesh 0.87
Assam 1.37 Gujarat 0.58 Telangana 0.79
For hospitals with 201 - 300 beds:
India 1.36 Kerala 0.52 Kerala 0.78

Odisha 1.22 Chhattisgarh 0.50 India 0.77
Rajasthan 1.21 Telangana 0.49 Ladakh 0.76
Himachal Pradesh 1.16 Andhra Pradesh 0.45 Assam 0.74
Bihar 1.12 Tamil Nadu 0.45 Madhya Pradesh 0.70
Kerala 1.08 Punjab 0.43 Uttar Pradesh 0.66
Uttar Pradesh 1.05 Ladakh 0.42 Himachal Pradesh 0.60
Andhra Pradesh 1.03 Odisha 0.41 Karnataka 0.58
Karnataka 0.92 Karnataka 0.37 Tamil Nadu 0.56
Tamil Nadu 0.76 Uttar Pradesh 0.36 Bihar 0.54
Punjab 0.56 Bihar 0.35 Gujarat 0.51
Gujarat Himachal Pradesh

0.38 0.33 Chhattisgarh 0.44
Meets
Meets
Meets
requirement
requirement
requirement
300 beds in position to the IPHS requirement of 66 paramedical staff

Figure A2.3-3: State/UT-wise average ratio of paramedical staff in hospitals with up to
1
1
1
Delhi 2.84
Maharashtra 2.62 Maharashtra 0.86
Rajasthan Dadra & Nagar Haveli 0.85
2.17
Maharashtra 0.99
Delhi 0.85
Delhi 1.85
Kerala 0.96
West Bengal 0.81
Uttar Pradesh 1.61
Gujarat 0.91
Meghalaya 0.74
Assam 1.60
Meghalaya 0.91
Madhya Pradesh 0.69
Madhya Pradesh 1.50 Uttar Pradesh 0.90
Rajasthan 0.63
West Bengal 1.44 Rajasthan 0.87
India 0.57
India 1.39 India 0.86
Kerala 0.53
For hospitals with 301 - 400 beds:
Andhra Pradesh Odisha 0.85

1.18 Andhra Pradesh 0.49
West Bengal 0.84
Tamil Nadu 0.93 Assam 0.48
Madhya Pradesh 0.78
Meghalaya 0.78 Odisha 0.46
Andhra Pradesh 0.64
Kerala 0.63 Tamil Nadu 0.43
Tamil Nadu 0.62
Uttar Pradesh 0.41
Jharkhand 0.54
Assam 0.61
Karnataka 0.38
Odisha 0.43 Karnataka 0.58
Gujarat 0.35
Gujarat 0.40 Jharkhand 0.38
Jharkhand 0.07

Karnataka 0.31
Meets
Meets
Meets
requirement
requirement
requirement
400 beds in position to the IPHS requirement of 81 paramedical staff

Figure A2.4-3: State/UT-wise average ratio of paramedical staff in hospitals with up to

Annexures
107
108
Annexures
1
Delhi 2.82
Delhi 5.16 Delhi 1.75
Andhra Pradesh 2.20

Andhra Pradesh 4.00 Andhra Pradesh 1.18
Karnataka 2.02
Puducherry 3.56 Chandigarh 1.11
A & N Islands Odisha 1.90
2.69 Madhya Pradesh 0.89
Uttar Pradesh 2.39 Chandigarh 1.38
Karnataka 0.88

Odisha 2.21 India 1.29
A & N Islands 0.87
Maharashtra 2.10 Uttar Pradesh 1.18
West Bengal 0.86
Kerala 1.81 Punjab 1.12
Puducherry 0.81
Chandigarh 1.78 Puducherry 1.07
Odisha 0.80
Madhya Pradesh 1.74 Tamil Nadu 1.07
India 0.79
India 1.63 West Bengal 0.98
Maharashtra 0.70
Chhattisgarh 1.31 Meghalaya
Kerala 0.70 0.91
Tamil Nadu 1.23 Rajasthan 0.66 Rajasthan 0.88
For hospitals with more than 400 beds:
Karnataka 1.20 Meghalaya 0.63 Kerala 0.87

Rajasthan 1.16 Uttar Pradesh 0.60 Maharashtra 0.84
West Bengal 0.85 Tamil Nadu 0.54 A & N Islands 0.79
Meghalaya 0.67 Punjab 0.53 Chhattisgarh 0.71
Telangana 0.60 Chhattisgarh 0.52 Madhya Pradesh 0.67
Bihar 0.41 Telangana 0.48 Telangana 0.49
Punjab 0.29
in position to the IPHS requirement of 225 nurses

Bihar 0.13
Bihar 0.34
beds in position to the IPHS requirement of 68 doctors
Meets
Meets
Meets
requirement
requirement
requirement
than 400 beds in position to the IPHS requirement of 100 paramedical staff
Figure A2.5-3: State/UT-wise average ratio of paramedical staff in hospitals with more
Figure A2.5-1: State/UT-wise average ratio of doctors in hospitals with more than 400
Figure A2.5-2: State/UT-wise average ratio of nurses in hospitals with more than 400 beds
14
14
Chhattisgarh
14
14
Daman & Diu
14
13
Haryana Tamil Nadu
14
14
Telangana
Mizoram
14
Rajasthan Rajasthan
13 12 12
Telangana Haryana
14
Gujarat
Madhya Pradesh
13
Telangana Tamil Nadu
Bihar
13
Tamil Nadu Rajasthan Gujarat
12 12 11 11
Chhattisgarh
13 13 13 13 13
West Bengal
13
Goa
Himachal Pradesh
Andhra Pradesh
13
West Bengal
11 11
Jammu & Kashmir

Bihar Tripura
13
Andhra Pradesh
Chandigarh Sikkim
12
Karnataka Delhi
Madhya Pradesh
India
12
Karnataka Delhi
Punjab
12
India
12 12 12 12 12 12
India Maharashtra
11
10 10 10 10 10 10 10
Uttar Pradesh Odisha
12
Bihar
Assam
11
Maharashtra
12
Gujarat
Uttar Pradesh
11
Delhi
12
Madhya Pradesh Kerala
11
Odisha
beds) by State/UT
beds) by State/UT
Manipur
12
Odisha
10 10 10 9 9
11
Kerala Meghalaya
300 beds) by State/UT

11
Maharashtra Jharkhand
Meghalaya
Himachal Pradesh
11 Karnataka
Chhattisgarh
KPI 3: AVAILABILITY OF SUPPORT SERVICES
Puducherry
Jharkhand Uttar Pradesh
10
West Bengal
Punjab Mizoram
11 10 10 10
Kerala
10
9 9 9 9 9 9
Puducherry Arunachal Pradesh

Arunachal Pradesh
10
Uttarakhand
10 9
Assam
Assam Nagaland
10
3
A & N Islands
9 8 8
Ladakh
9
Ladakh
4
Availability of all identified services

A & N Islands
3
Punjab Lakshadweep
Figure A3-1: Average number of support services in small district hospitals (up to 200
Figure A3-3: Average number of support services in large district hospitals (more than
Figure A3-2: Average number of support services in mid-sized district hospitals (201–300

Annexures
109
Annexures
KPI 4: AVAILABILITY OF CORE HEALTH CARE SERVICES
14 13 13 Availability of all identified services

14 13 13 12
12 12 12 12
11 11 10 10
10 10 10 10 10 10
10 10 9
9 9 9 9 8
8 8
7 7
3
2
Odisha
Bihar
Nagaland
Telangana
Arunachal Pradesh
Ladakh
Rajasthan
Punjab
Haryana
Kerala
Tamil Nadu
Delhi
Assam
Tripura
India
A & N Islands
West Bengal
Daman & Diu
Karnataka
Meghalaya
Puducherry
Jammu & Kashmir
Mizoram
Uttar Pradesh
Himachal Pradesh
Madhya Pradesh
Gujarat
Maharashtra
Jharkhand
Manipur
Uttarakhand
Chhattisgarh
Sikkim
Lakshadweep
Figure A4-1: Average number of core health care services in small district hospitals (up to
14 14 14 14 Availability of all identified services

13 13 13 13 13
14 13 13 13 13
12 12 12 12 12 12
11 11
11 11
10
Mizoram
Telangana
Goa
West Bengal
Maharashtra
Delhi
Ladakh
Punjab
Rajasthan
Himachal Pradesh
Odisha
Tamil Nadu
Gujarat
Karnataka
India
Arunachal Pradesh
Chhattisgarh
Haryana
Madhya Pradesh
Bihar
Andhra Pradesh
Assam
Uttar Pradesh
Kerala
Figure A4-2: Average number of core health care services in mid-sized district hospitals
(201–300 beds) by State/UT
14 14 14 14 13 13 Availability of all identified services

13 13 13 13 13 13
14 13 13 12 12 12
12 12
11 11 11
10 10
Haveli Nagar & Dadra
Assam
Islands N & A
Chha�sgarh
Pradesh U�ar
Meghalaya
Puducherry
Punjab
Bengal West
Telangana
Pradesh Andhra
Bihar
Chandigarh
Gujarat
Odisha
Kerala
Nadu Tamil
Rajasthan
Maharashtra
India
Delhi
Karnataka
Pradesh Madhya
Jharkhand
Figure A4-3: Average number of core health care services in large district hospitals (more
than 300 beds) by State/UT

Annexures
KPI 5: AVAILABILITY OF DIAGNOSTIC TESTING SERVICES
14 Availability of all identified services

14
11 11 11 11 11
10 10 10 10 10
9 9 9
9 9 8 8 8 8 8
8 8 8 8 8 8
7
7 7 6 6
6
4
U�ar Pradesh
Puducherry
Meghalaya
Rajasthan
Maharashtra
Telangana
Haryana
Jammu & Kashmir
Kerala
Madhya Pradesh
Himachal Pradesh
Daman & Diu
Jharkhand
Manipur
Karnataka
Bihar
Arunachal Pradesh
India
Ladakh
West Bengal
Punjab
Delhi
Mizoram
Odisha
Assam
Nagaland
Tripura
Tamil Nadu
Sikkim
Lakshadweep
Gujarat
A & N Islands
U�arakhand
Chha�sgarh
Figure A5-1: Average number of diagnostic testing services in small district hospitals (up
to 200 beds) by State/UT

14 13 13
12 12 12 12
11 11 11
10 10 10 10 10
9 9 9 9 9 9 8 8
Mizoram
Telangana
Goa
Punjab
Ladakh
Gujarat
Delhi
Haryana
Andhra Pradesh
Maharashtra
Tamil Nadu
Odisha
Karnataka
Arunachal Pradesh
India
Himachal Pradesh
Madhya Pradesh
Bihar
Rajasthan
Assam
Uttar Pradesh
West Bengal
Kerala
Chhattisgarh
Figure A5-2: Average number of diagnostic testing services in mid-sized district hospitals

14 13 13
12 12 12 12 12
11 11 10 10
10 10 10 10 10 10 10
9
8 8
5
Dadra & Nagar…
Telangana
Gujarat
Andhra Pradesh
Delhi
Chandigarh
Punjab
Tamil Nadu
Karnataka
India
Rajasthan
Maharashtra
Uttar Pradesh
Assam
Kerala
Meghalaya
West Bengal
Madhya Pradesh
Odisha
Puducherry
Jharkhand
Bihar
Chhattisgarh
A & N Islands
Figure A5-3: Average number of diagnostic testing services in large district hospitals
(more than 300 beds) by State/UT

112
Annexures

90
90
90
Chandigarh 90.00 Andhra Pradesh 90.00 West Bengal 90.00

Tamil Nadu 83.87
Dadra & Nagar Haveli 90.00 Punjab 90.00 Maharashtra 82.95
Punjab 90.00 Telangana 90.00 Delhi 77.36
Punjab 73.87
Telangana 87.21 West Bengal 90.00

Haryana 73.53
Maharashtra 83.20 Maharashtra 84.32 Kerala 70.63
West Bengal 81.94 Delhi Mizoram 67.04
83.67
Odisha 65.21
Tamil Nadu 77.06 Bihar 79.09 Meghalaya 63.87
Andhra Pradesh 74.56 Assam 77.99 Madhya Pradesh 63.77
Assam 60.28
A & N Islands 73.94 Mizoram 77.99 Sikkim 59.60
Rajasthan Odisha Gujarat
KPI 6: BED OCCUPANCY RATE
66.81 69.33 57.00

India Tripura 56.50
65.87 Madhya Pradesh 66.96
Bihar 55.24
Odisha 64.09 Haryana 66.85 India 53.44
Madhya Pradesh 63.58 Arunachal Pradesh 64.49 Rajasthan 52.28
Chhattisgarh 52.26
Delhi 61.93 Kerala 64.38 Jammu & Kashmir 48.01
Karnataka India Uttar Pradesh 46.45
by State/UT
61.08 59.94
Telangana 45.00
Kerala 55.83 Chhattisgarh 58.91
Uttarakhand 44.48
beds) by State/UT
beds) by State/UT
Chhattisgarh 50.02 Karnataka 58.82 Puducherry 43.90
Meghalaya 45.60 Tamil Nadu Ladakh 40.66
57.91
Jharkhand 38.69
Assam 45.03 Rajasthan 47.90 Himachal Pradesh 33.77
Uttar Pradesh 44.39 Gujarat 46.22 Daman & Diu 33.35
Nagaland 26.39
Puducherry 44.21 Uttar Pradesh 35.88 Karnataka 24.15
Jharkhand 21.92 Goa 33.95 Manipur 23.98
Bihar Lakshadweep 22.73
21.15 Himachal Pradesh 32.46
A & N Islands 13.23
Gujarat 12.12 Ladakh 21.36 Arunachal Pradesh 12.76
Desired maximum rate

Figure A6-2: Average bed occupancy rate (%) in mid-sized district hospitals (201–300
Figure A6-3: Average bed occupancy rate (%) in large district hospitals (more than 300
Figure A6-1: Average bed occupancy rate (%) in small district hospitals (up to 200 beds)
A & N Islands 0.00
West Bengal 1.88
Meghalaya 4.25
Bihar Uttar Pradesh 0.00
1.84 Uttarakhand 5.36
Uttar Pradesh Rajasthan 8.75
7.52 Bihar 5.51
Meghalaya 8.23 Bihar 10.74 Rajasthan 6.19
Gujarat Himachal Pradesh 16.62 Uttar Pradesh 9.26
11.06
Madhya Pradesh Madhya Pradesh 9.57
Rajasthan 17.81 16.63
KPI 7: C-SECTION RATE
Chhattisgarh 9.76
Madhya Pradesh 19.66 Delhi 17.19
Jharkhand 10.38
Chhattisgarh 19.67 Chhattisgarh 18.27 Manipur 10.58
Assam 21.67 Odisha 22.80 Arunachal Pradesh 11.21
Maharashtra 23.09 Gujarat 23.58 Sikkim 12.43
Gujarat 14.24
Kerala 26.82 Haryana 23.66
Tripura 14.58
Jharkhand 27.35 India 25.08 Delhi 15.70
Delhi 29.78 Mizoram 25.63 India 16.03
Odisha 31.28 Ladakh 28.15 Himachal Pradesh 16.07
India 31.39 Maharashtra 28.53 Haryana 16.60
Chandigarh Mizoram 18.84
32.21 Assam 31.69
Ladakh 19.86
Karnataka 33.53 West Bengal 32.23 Nagaland 21.14
A & N Islands 34.43 Punjab 34.21 Odisha 21.48
West Bengal 35.04 Goa 37.09 Maharashtra 25.26

Punjab 34.35
than 300 beds) by State/UT

Punjab 36.99 Arunachal Pradesh 39.15
Dadra & Nagar Haveli Puducherry 35.18
39.76 Andhra Pradesh 40.73
Jammu & Kashmir 35.76
Andhra Pradesh 43.86 Kerala 41.82 Assam 37.22
Puducherry 51.74 Karnataka 45.67 Telangana 42.30
Tamil Nadu 55.68 Telangana 48.92 Lakshadweep 44.22
Telangana 69.33 Karnataka 46.55
Tamil Nadu 50.88
Kerala 46.63
Daman & Diu 48.79
Tamil Nadu 59.96
Figure A7-2: Average percentage of C-section deliveries in mid-sized district hospitals

Figure A7-1: Average percentage of C-section deliveries in small district hospitals (up to
Figure A7-3: Average percentage of C-section deliveries in large district hospitals (more

Annexures
113
114
Annexures

Rajasthan 326
Gujarat 322
Telangana 846 Delhi 2262
Delhi 314
Puducherry 814 Bihar 1202 Telangana 308
Tamil Nadu 523 Haryana 426 Tamil Nadu 302
Haryana 301
Kerala 498 Himachal Pradesh 389

Jammu & Kashmir 240
Delhi 390 Tamil Nadu 325 Punjab 233
Uttar Pradesh 331 Telangana 318 Bihar 160
India 300 Gujarat 301 Puducherry 149
India 140
Karnataka 296 Uttar Pradesh 281 Uttar Pradesh 138
Dadra & Nagar Haveli 295 India 262 Madhya Pradesh 126
Rajasthan 282 Mizoram 226 Uttarakhand 125
Maharashtra 106
Punjab 253 Goa 215
Assam 94
Chandigarh 242 Rajasthan 205 Daman & Diu 94
Meghalaya 195 Karnataka 192 Odisha 81
A & N Islands Maharashtra Karnataka 79
189 179
Kerala 75
Odisha 183 West Bengal 145 Himachal Pradesh 56
Andhra Pradesh 183 Arunachal Pradesh 134 Mizoram 51
KPI 8: SURGICAL PRODUCTIVITY INDEX
Gujarat 174 Andhra Pradesh 133 Nagaland 47

Chhattisgarh 39
Maharashtra 170 Punjab 120 Meghalaya 36
West Bengal 167 Madhya Pradesh 100 Jharkhand 31
Madhya Pradesh 142 Odisha 87 Lakshadweep 24
Manipur 21
Chhattisgarh 113 Ladakh 85
hospitals (up to 200 beds) by State/UT
Arunachal Pradesh 9
Assam 81 Chhattisgarh 81 Tripura 7
hospitals (more than 300 beds) by State/UT

district hospitals (201–300 beds) by State/UT
Bihar 0 Assam 72 Sikkim 2
Jharkhand Kerala Ladakh 1
0 47
West Bengal 1
A & N Islands 0
Figure A8-2: Average number of surgeries per surgeon performed in a year in mid-sized
Figure A8-1: Average number of surgeries per surgeon performed in a year in small district
Figure A8-3: Average number of surgeries per surgeon performed in a year in large district
Gujarat
44
Tamil Nadu
57
Uttar Pradesh
53
Uttar Pradesh
42
Uttar Pradesh Tamil Nadu

Madhya Pradesh
50
Telangana Telangana
4040
43 41
47
Kerala
Delhi
Chandigarh
37 37
Puducherry
Haryana
39 38
Bihar
36
Tamil Nadu
38 37
Delhi
33
Himachal Pradesh
37
Karnataka
Daman & Diu
KPI 9: OPD PER DOCTOR
Bihar
33
A & N Islands
29 27
Punjab
30 29
Karnataka
29
India India
India Himachal Pradesh
27
Bihar
26 26
Haryana
28 27 26
Maharashtra Andhra Pradesh

Jammu & Kashmir
Rajasthan Madhya Pradesh
23 22
Madhya Pradesh
24 24 22
Assam Rajasthan Uttarakhand

Odisha
Punjab Gujarat
20 19
Karnataka
Odisha
20 20 19 19 19
Punjab
21 20 19
West Bengal
Puducherry Chhattisgarh A & N Islands
18 18 17
Lakshadweep
Kerala
19 17
Maharashtra
15
Rajasthan
18 17 17
Delhi Assam Jharkhand
13 13
Chhattisgarh Assam
Mizoram
16 16
Maharashtra
16 15
West Bengal Odisha Chhattisgarh
11
Andhra Pradesh
11 10 10
Goa Sikkim
hospitals (201–300 beds) by State/UT

hospitals (up to 200 beds) by State/UT
11
Gujarat Mizoram
Jammu & Kashmir
8 8
Tripura
hospitals (more than 300 beds) by State/UT

8
Meghalaya
14 14 14 13
Kerala Arunachal Pradesh
2
Jharkhand
Meghalaya
6
Arunachal Pradesh
0
Telangana Manipur
West Bengal 0
6 6 5 5
Nagaland
Figure A9-1: Average number of OPD patients per doctor in a day in small district
Figure A9-3: Average number of OPD patients per doctor in a day in large district
Figure A9-2: Average number of OPD patients per doctor in a day in mid-sized district

Annexures
115
116
Annexures
Karnataka

0
Chhattisgarh Kerala
0
Jharkhand Lakshadweep
0
Maharashtra
Tamil Nadu
0
Meghalaya
0
Haryana
Haryana
1
Chandigarh 0 0 0 0 2 2
0
Arunachal Pradesh Sikkim
1
Telangana

1
Tamil Nadu Punjab
6 8
3
Maharashtra Himachal Pradesh
4
Punjab
Nagaland
4
Punjab
9
Goa
10 10
Ladakh
7
Tamil Nadu
9
West Bengal Telangana
Puducherry
15 17
Daman & Diu

Karnataka
West Bengal Tripura
Odisha
10 10
Mizoram
19 23
Karnataka
15 16 18
13
Himachal Pradesh Meghalaya
India
Mizoram Rajasthan
19
Kerala Uttarakhand
India
Madhya Pradesh
27 28 28 30
Delhi
Delhi Puducherry
Ladakh Arunachal Pradesh
34 35 36
Odisha
26 27 27 27 29
Gujarat
32 33 35
Gujarat
38
Rajasthan Manipur
37
Rajasthan India
Chhattisgarh
Kerala Assam
39 40
47 48
KPI 10: BLOOD BANK REPLACEMENT RATE
Andhra Pradesh
35 36 37
Odisha
Andhra Pradesh
52
Uttar Pradesh Jammu & Kashmir
46 49
Uttar Pradesh
Madhya Pradesh Uttar Pradesh
46 46
50 51
Assam Chhattisgarh
Assam
63
Jharkhand
55
Bihar
54 56 56
Bihar
92
district hospitals (up to 200 beds) by State/UT
Bihar
Telangana
Gujarat
sized district hospitals (201–300 beds) by State/UT

Maharashtra
66 66
district hospitals (more than 300 beds) by State/UT

100
Madhya Pradesh
57 58
Delhi
74
A & N Islands
96
Figure A10-2: Average percentage of blood units issued on replacement in a year in mid-
Figure A10-1: Average percentage of blood units issued on replacement in a year in small
Figure A10-3: Average percentage of blood units issued on replacement in a year in large
Annexures
ANNEXURE 6
LIST OF DISTRICT HOSPITALS HAVING ALL REQUISITE SERVICES

(SUPPORT SERVICES, CORE HEALTH CARE SERVICES, DIAGNOSTIC
TESTING SERVICES)
ANNEXURE 6 - TABLE 6A: LIST OF DISTRICT HOSPITALS HAVING

ALL IDENTIFIED SUPPORT SERVICES (N=14)
Hospital
State/UT District District Hospital
category*
Chittoor Govt. Maternity Hospital TH M
Andhra Pradesh
Nellore Govt. General Hospital Nellore L
Bihar Sitamarhi Sadar Hospital Sitamarhi S
Chhattisgarh Dhamtari DH Dhamtari M

Dadra and Nagar Dadra and Nagar Shri Vinoba Bhave Civil Hospital L
Haveli Haveli
Daman Government Hospital Daman S
Daman and Diu
Diu Government Hospital Diu S
Goa North Goa North Goa District Hospital M
Devbhumi Dwarka Jam Khambhalia S
Gujarat Mahesana General Hospital Mehsana M
Panch Mahals General Hospital Godhra M
Bhiwani Civil Hospital M
Hisar Civil Hospital S
Kaithal IGMS Civil Hospital S
Haryana Kurukshetra LNJP Civil Hospital S
Panchkula Civil Hospital M
Rohtak Civil Hospital S
Sonipat Civil Hospital Sonepat S
Jammu and Baramula Baramula DH S

Kashmir Pulwama Pulwama DH S
Bangalore Urban KC General Hospital L
Karnataka Chitradurga Chitradurga District Hospital FRU L

Dakshina Kannada Lady Goshan Hospital Mangalore DH M
FRU
* Hospital category - S: small (up to 200 beds); M: mid-sized (201-300 beds); L: large (more than 300 beds)

Annexures
Hospital
category*
Dharwad Dharwad District Hospital FRU M
Gulbarga Gulbarga District Hospital FRU L
Hassan Hassan District Hospital L
Karnataka
Koppal Koppal District Hospital FRU M
Mandya Mandya District Hospital L
Shimoga Shimoga District Hospital L
Kerala Ernakulam GH Ernakulam L
Harda DH Harda S
Jhabua DH Jhabua S
Madhya Pradesh
Satna DH Satna L
Tikamgarh DH Tikamgarh S
Amravati District General Hospital Amravati L
Maharashtra
Raigarh DH Alibag M
Mizoram Aizawl West Aizawl Civil Hospital M
Balangir DH Balangir M
Odisha Baleshwar DH Balasore L
Kendrapara DH Kendrapada S
Ajmer A K Hospital Beawar Ajmer L
Chittaurgarh District Hospital Chittaurgarh L
Churu D B Government Hospital Churu M
Dausa District Hospital Dausa M
Dhaulpur Sadar Hospital Dholpur L
Rajasthan
Ganganagar Govt Hospital Sriganganagar L
Hanumangarh DH Hanumangarh Town L
Jaisalmer Jawahar Hospital Jaisalmer S
Jhunjhunun B.D.K. Hospital Jhunjhunun S
Rajsamand R K District Hospital Rajsamand M
Ariyalur DH Ariyalur M
Coimbatore DH Pollachi L
Dindigul DH Dindigul L
Tamil Nadu Erode DH Erode L
Kanniyakumari DH Padhmanabapuram S
Madurai DH Usilampatti S
Nagapattinam DH Nagapattinam L

Annexures
Hospital
category*
Namakkal DH Namakkal L
Nilgiris DH Uthagamandalam L
Ramanathapuram DH Ramanathapuram L
Salem DH Mettur Dam M
Theni DH Periakulam M
Tamil Nadu Thiruvallur DH Thiruvallur L
Thiruvarur DH Mannargudi L
Tiruchirappalli DH Manapparai M
Tirunelveli DH Tenkasi M
Toothukudi DH Kovilpatti L
Virudhunagar DH Virudhunagar L
Khammam DH Khammam M
Nalgonda DH Nalgonda L
Telangana
Sangareddy DH Sangareddy M
Vikarabad DH Tandur S
Allahabad Moti Lal Nehru District Hospital S
Ambedkar Nagar Mahatma Jyotiba Phule District S
Hospital
Azamgarh District Hospital Azamgarh M
Budaun District Hospital Badaun M
Lucknow DH Ram Manohar Lohiya L
Uttar Pradesh
Maharajganj District Combined Hospital S
Rampur District Male Hospital S
Sant Kabir Nagar District Combined Hospital Sant Kabir S
Nagar
Varanasi Pt. Deen Dayal Upadhyay Govt S
Hospital
Alipurduar Alipurduar District Hospital M
Dakshin Dinajpur Balurghat DH & SSH L
Jalpaiguri Jalpaiguri DH & SSH L
Koch Bihar MJN District Hospital L
West Bengal
Nadia District Hospital Nadia L
Purba Medinipur Tamluk District Hospital L
Puruliya D.M. Sadar DH & SSH L
Uttar Dinajpur Raiganj DH & SSH L

Annexures
ANNEXURE 6 - TABLE 6B: LIST OF DISTRICT HOSPITALS HAVING

ALL IDENTIFIED CORE HEALTH CARE SERVICES (N=14)
Hospital
category*
Anantapur GGH Anantapur L
East Godavari DH Rajahmundry M
Andhra Pradesh Nellore Govt. General Hospital Nellore L
Prakasam RIMS Ongole TH L
Srikakulam RIMS Srikakulam TH L
Assam Sibsagar Sivasagar Civil Hospital L
Dadra and Nagar Dadra and Nagar

Shri Vinoba Bhave Civil Hospital L
Haveli Haveli
Sanjay Gandhi Memorial Hospital

Delhi Delhi North West M
Mangolpuri
Goa South Goa South Goa District Hospital M
Amreli General Hospital Amreli M
Dahod General Hospital Dahod L
Gujarat Panch Mahals General Hospital Godhra M
Tapi General Hospital Vyara M
The Dangs General Hospital Dang S
Bilaspur Bilaspur RH M
Himachal Pradesh Mandi Mandi ZH M
Sirmaur Nahan RH M
Bagalkote Bagalkote District Hospital FRU M
Bangalore Urban Jayanagar General Hospital M
Bidar Bidar District Hospital L
Chamrajnagar Chamarajnagar District Hospital FRU M
Karnataka Dharwad Hubli KIMS District Hospital L
Gulbarga Gulbarga District Hospital FRU L
Kodagu Kodagu District Hospital FRU L
Kolar Kolar District Hospital FRU L

Annexures
Hospital
category*
Mandya Mandya District Hospital L
Raichur Raichur District Hospital L
Karnataka Shimoga Shimoga District Hospital L
Tumkur Tumkur District Hospital FRU L
Uttara Kannada Uttara Kannada District Hospital FRU L
Ernakulam DH Aluva M
Ernakulam GH Ernakulam L
Kannur GH Thalassery L
Kasaragod DH Kanhangad L
Kozhikode General Hospital Calicut L

Kerala
Malappuram DH Tirur S
Malappuram GH Manjeri L
Pathanamthitta General Hosp Pathanamthitta L
Thrissur GH Thrissur M
Wayanad DH Mananthavady M
Madhya Pradesh Satna DH Satna L
Ahmednagar DH Ahmednagar M
Beed District Hospital Beed L
Nashik District Hospital Nashik L
Pune DH Aundh L
Maharashtra Raigarh DH Alibag M
Ratnagiri District Hospital Ratnagiri S
Lt Karntisigh Nana Patil Civil Hospital

Satara M
Satara
Thane District Hospital Thane M
Balangir DH Balangir M
Baleshwar DH Balasore L
Odisha Khordha Capital Hospital L
Mayurbhanj DH Baripada M
Puri DH Puri L
Karaikal Govt. General Hospital L

Puducherry
Mahe Govt. General Hospital S

Annexures
Hospital
category*
Punjab Jalandhar Jalandhar DH L
Bharatpur RBM Hospital, Bharatpur L
Churu D B Government Hospital Churu M
Ganganagar Govt Hospital Sriganganagar L
Hanumangarh DH Hanumangarh Town L
Rajasthan Jhunjhunun B.D.K. Hospital Jhunjhunun S
Karauli General Hospital Karauli M
Rajsamand R K District Hospital Rajsamand M
Sikar S K Hospital, Sikar L
Tonk District Sahadat Hospital Tonk S
Ariyalur DH Ariyalur M
Tamil Nadu Chennai Kilpauk Hospital L
Cuddalore DH Cuddalore L
Dindigul DH Dindigul L
Erode DH Erode L
Kancheepuram DH Kancheepuram L
Karur DH Kulithalai S
Krishnagiri DH Krishnagiri L
Namakkal DH Namakkal L
Ramanathapuram DH Ramanathapuram L
Tamil Nadu
Salem DH Mettur Dam M
Sivaganga DH Karaikudi M
Thiruvallur DH Thiruvallur L
Tirupur DH Tiruppur L
Toothukudi DH Kovilpatti L
Vellore DH Walajapet M
Virudhunagar DH Virudhunagar L
Karim Nagar DH Karimnagar L
Telangana
Uttar Pradesh Lucknow DH Ram Manohar Lohiya L

Annexures
Hospital
category*
Birbhum Rampuhat DH & SSH M
Darjiling Siliguri DH L
Darjiling Darjeeling DH L
Hugli Imambara District Hospital L
Jalpaiguri Jalpaiguri DH & SSH L
Jhargram Jhargram DH & SSH L

West Bengal North Twenty Four
Barasat DH L
Parganas
Paschim
Asansol DH & SSH L
Barddhaman
Purba Medinipur Tamluk District Hospital L
Puruliya D.M. Sadar DH & SSH L
South Twenty Four

M. R. Bangur DH & SSH L
Parganas
ANNEXURE 6 - TABLE 6C: LIST OF DISTRICT HOSPITALS HAVING

ALL IDENTIFIED DIAGNOSTIC TESTING SERVICES (N=14)
Hospital
category*
Nellore Govt. General Hospital Nellore L
Andhra Pradesh Srikakulam RIMS Srikakulam TH L
Vishakapatnam King George Hospital TH L
Dadra and Nagar Dadra and Nagar

Shri Vinoba Bhave Civil Hospital L
Haveli Haveli
Delhi Delhi South Pt. Madan Mohan Malviya Hospital S
Dahod General Hospital Dahod L

Gujarat
Panch Mahals General Hospital Godhra M
Bangalore Urban Vanivilas Hospital L
Bellary VIMS Bellary Medical College L
Dakshina Kannada Wenlock Hospital Mangalore DH L

Karnataka
Dharwad Hubli KIMS District Hospital L
Shimoga Shimoga District Hospital L

Annexures
Hospital
category*
Maharashtra Gadchiroli District Hospital Gadchiroli M
Rajasthan Bhilwara M G Hospital Bhilwara L
Tamil Nadu Chennai Kilpauk Hospital L
Karim Nagar Karimnagar L
Telangana

Annexures
ANNEXURE 7
KPI-WISE RAW SCORES FOR DISTRICT HOSPITALS
Key
Name of the KPI Numerator (Num.) Denominator (Den.) Raw Score
KPI
Table A
No. of functional Num. ×
No. of functional beds
KPI 1 hospital beds per District population 100000 /
available in the hospital
100,000 population Den.
Ratio of doctors No. of doctors
No. of doctors required
KPI 2.1 in position to IPHS positioned in the Num. / Den.
as per IPHS norm
norms hospital
Ratio of staff nurses No. of staff nurses No. of staff nurses
KPI 2.2 in position to IPHS positioned in the required as per IPHS Num. / Den.
norms hospital norm
Ratio of paramedical No. of paramedical staff No. of paramedical staff
KPI 2.3 staff in position to are positioned in the required as per IPHS Num. / Den.
IPHS norms hospital norm
Availability of support Total no. of support Total services identified
KPI 3 Num. / Den.
services services available (N=14)
Availability of core Total no. of core health Total services identified
KPI 4 Num. / Den.
health care services care services available (N=14)
Availability of Total no. of diagnostic
Total services identified
KPI 5 diagnostic testing testing services Num. / Den.
(N=14)
services available
Table B
Total number of (Num. ×
No. of functional beds
KPI 6 Bed occupancy rate inpatient bed days in a 100) / (Den.
available in the hospital
year × 365)
Total number of
Total number of
deliveries performed in a Num. × 100
KPI 7 C-section rate C-section deliveries
year (Normal + Assisted / Den.
performed in a year
Deliveries + C Section)
Total number of major
Total number of
surgeries in a year
surgeons in this hospital
Surgical Productivity (excluding - Obstetrics
KPI 8 (excluding Obstetric/ Num. / Den.
Index & Gynecology,
Gynecological Surgeon
Ophthalmology
& Ophthalmologist)
Surgeries)
Total number of OPD (i) Total number of OPD
patients in a year days in a year Num. / (i)
KPI 9 OPD per doctor
(Allopathic + AYUSH (ii) Total number of × (ii)
outpatient attendance) positioned doctors
Total number of blood
Total number of
Blood bank units issued in a year Num. × 100
KPI 10 blood units issued on
replacement rate (inclusive voluntary / Den.
replacement in a year
blood donation)

126
ANNEXURE 7 - TABLE 7A - KPIs 1-5
Total Total Total

Annexures
Dist Hospital Raw Raw Raw

DH Code Num. Den. Raw Score Num. Den. Num. Den. Num. Den. services services services
Code category Score Score Score
available available available
KPI 1 KPI 2.1 KPI 2.2 KPI 2.3 KPI 3 KPI 4 KPI 5
D1 DH1 S 126 36842 342.00 8 34 0.24 25 90 0.28 41 42 0.98 4 2 6

D2 DH2 S 60 105597 56.82 12 29 0.41 16 45 0.36 43 31 1.39 4 1 7
D3 DH3 L 476 238142 199.88 54 68 0.79 196 225 0.87 269 100 2.69 3 11 5

D4 DH4 L 500 4081148 12.25 135 68 1.99 161 225 0.72 235 100 2.35 13 14 11
D5 DH5 M 300 895721.9 33.49 35 50 0.70 31 135 0.23 40 66 0.61 14 4 9
D5 DH6 L 1098 3278342 33.49 157 68 2.31 198 225 0.88 327 100 3.27 13 13 13
D6 DH7 L 350 2882469 12.14 29 58 0.50 74 180 0.41 30 81 0.37 12 13 13
D7 DH8 M 250 5154296 4.85 40 50 0.80 86 135 0.64 149 66 2.26 13 14 13
D8 DH9 M 257 4887813 5.26 38 50 0.76 57 135 0.42 23 66 0.35 11 11 11
D9 DH10 L 350 4517398 7.75 39 58 0.67 60 180 0.33 36 81 0.44 10 13 13
D10 DH11 M 300 4053463 7.40 46 50 0.92 71 135 0.53 24 66 0.36 12 13 11
D11 DH12 L 1077 2963557 36.34 103 68 1.51 341 225 1.52 22 100 0.22 14 14 14
D12 DH13 L 500 3397448 14.72 93 68 1.37 197 225 0.88 286 100 2.86 12 14 11
D13 DH14 L 500 2703114 18.50 89 68 1.31 229 225 1.02 459 100 4.59 13 14 14
D14 DH15 L 2042 4290589 47.59 320 68 4.71 461 225 2.05 1071 100 10.71 12 13 14
D15 DH16 M 300 2344474 12.80 59 50 1.18 62 135 0.46 103 66 1.56 13 13 12
D16 DH17 L 350 3936966 8.89 43 58 0.74 131 180 0.73 220 81 2.72 12 13 10
Note:
Hospital category - S: small (up to 200 beds); M: mid-sized (201-300 beds); L: large (more than 300 beds)
0 - data not provided/ error in submitted data
Total Total Total
D17 DH18 S 150 99214 151.19 49 34 1.44 36 90 0.40 135 42 3.21 10 12 10
D18 DH19 S 68 145726 46.66 21 29 0.72 21 45 0.47 32 31 1.03 5 7 6
D19 DH20 S 72 54080 133.14 11 29 0.38 25 45 0.56 13 31 0.42 11 4 3
D20 DH21 M 254 176573 143.85 105 50 2.10 124 135 0.92 221 66 3.35 10 12 10
D21 DH22 S 38 49977 76.03 13 29 0.45 14 45 0.31 86 31 2.77 9 7 6
D22 DH23 S 80 112274 71.25 22 29 0.76 25 45 0.56 119 31 3.84 8 9 7
D23 DH24 S 70 950075 7.37 21 29 0.72 24 45 0.53 12 31 0.39 9 7 8
D24 DH25 S 45 1693622 2.66 22 29 0.76 22 45 0.49 12 31 0.39 13 10 9
D25 DH26 S 160 738804 21.66 25 34 0.74 38 90 0.42 101 42 2.40 11 11 8
D26 DH27 S 82 1736617 4.72 21 29 0.72 35 45 0.78 92 31 2.97 9 7 7
D27 DH28 S 100 482162 20.74 15 29 0.52 32 45 0.71 9 31 0.29 8 8 7
D28 DH29 S 200 928500 21.54 29 34 0.85 66 90 0.73 26 42 0.62 8 10 8
D29 DH30 S 160 686133 23.32 27 34 0.79 63 90 0.70 22 42 0.52 9 10 8
D30 DH31 S 200 1949258 10.26 30 34 0.88 63 90 0.70 18 42 0.43 11 11 10
D31 DH32 S 136 214102 63.52 20 34 0.59 44 90 0.49 109 42 2.60 9 10 9
D32 DH33 S 200 1008183 19.84 29 34 0.85 31 90 0.34 134 42 3.19 11 12 11
D33 DH34 L 325 1066888 30.46 31 58 0.53 78 180 0.43 22 81 0.27 9 10 9
D34 DH35 S 102 659296 15.47 16 34 0.47 35 90 0.39 97 42 2.31 9 8 7
D35 DH36 S 50 1253938 3.99 30 29 1.03 29 45 0.64 14 31 0.45 8 8 9
D36 DH37 S 40 1517542 2.64 25 29 0.86 15 45 0.33 47 31 1.52 12 10 6
D37 DH38 S 200 956313 20.91 52 34 1.53 65 90 0.72 27 42 0.64 9 10 8

Annexures
127
128
Total Total Total
Annexures
D38 DH39 S 169 1228686 13.75 32 34 0.94 48 90 0.53 114 42 2.71 11 13 8
D39 DH40 S 200 887142 22.54 29 34 0.85 68 90 0.76 14 42 0.33 11 13 10

D40 DH41 M 220 1042137 21.11 43 50 0.86 104 135 0.77 21 66 0.32 9 10 7
D41 DH42 S 150 957423 15.67 34 34 1.00 46 90 0.51 73 42 1.74 10 11 10
D42 DH43 L 302 2823768 10.69 39 58 0.67 93 180 0.52 197 81 2.43 9 11 11

D43 DH44 M 235 771639 30.45 39 50 0.78 57 135 0.42 117 66 1.77 11 12 10
D44 DH45 L 309 1151050 26.85 37 58 0.64 86 180 0.48 169 81 2.09 9 14 10
D45 DH46 M 262 1924110 13.62 29 50 0.58 78 135 0.58 133 66 2.02 9 10 9
D46 DH47 S 150 1327929 11.30 31 34 0.91 71 90 0.79 60 42 1.43 10 11 8
D47 DH48 S 121 831668 14.55 20 34 0.59 42 90 0.47 20 42 0.48 8 10 9
D48 DH49 S 100 2811569 3.56 17 29 0.59 15 45 0.33 41 31 1.32 12 8 6
D49 DH50 S 97 700843 13.84 18 29 0.62 19 45 0.42 28 31 0.90 11 9 8
D50 DH51 S 114 2540073 4.49 17 34 0.50 16 90 0.18 40 42 0.95 12 9 6
D51 DH52 S 124 2034763 6.09 16 34 0.47 47 90 0.52 56 42 1.33 11 8 8
D52 DH53 S 108 2970541 3.64 22 34 0.65 49 90 0.54 14 42 0.33 13 12 10
D53 DH54 S 30 3037766 0.99 22 29 0.76 26 45 0.58 11 31 0.35 11 9 9
D54 DH55 S 150 2728407 5.50 35 34 1.03 37 90 0.41 14 42 0.33 12 13 8
D55 DH56 S 100 1706352 5.86 23 29 0.79 27 45 0.60 39 31 1.26 11 11 5
D56 DH57 S 160 5099371 3.14 33 34 0.97 31 90 0.34 48 42 1.14 11 13 8
D57 DH58 S 60 4391418 1.37 12 29 0.41 50 45 1.11 59 31 1.90 10 6 9
D58 DH59 S 105 2562012 4.10 21 34 0.62 21 90 0.23 37 42 0.88 12 13 8

Total Total Total
D59 DH60 S 100 1760405 5.68 12 29 0.41 25 45 0.56 39 31 1.26 10 9 5
D60 DH61 S 100 1125313 8.89 32 29 1.10 54 45 1.20 14 31 0.45 9 13 9
D61 DH62 S 102 1626384 6.27 15 34 0.44 29 90 0.32 42 42 1.00 12 10 6
D62 DH63 S 120 3071029 3.91 19 34 0.56 30 90 0.33 55 42 1.31 12 11 8
D63 DH64 S 100 1666886 6.00 14 29 0.48 53 45 1.18 11 31 0.35 12 12 8
D64 DH65 S 100 1690400 5.92 14 29 0.48 20 45 0.44 67 31 2.16 12 9 8
D65 DH66 S 75 1000912 7.49 16 29 0.55 48 45 1.07 17 31 0.55 12 10 1
D66 DH67 S 80 2001762 4.00 14 29 0.48 30 45 0.67 10 31 0.32 13 11 8
D67 DH68 S 110 4487379 2.45 21 34 0.62 43 90 0.48 55 42 1.31 10 12 8
D68 DH69 S 160 1367765 11.70 26 34 0.76 50 90 0.56 84 42 2.00 11 11 7
D69 DH70 S 164 4801062 3.42 20 34 0.59 34 90 0.38 57 42 1.36 10 12 9
D70 DH71 M 300 2877653 10.43 24 50 0.48 50 135 0.37 59 66 0.89 10 11 9
D71 DH72 S 82 2219146 3.70 18 29 0.62 52 45 1.16 102 31 3.29 13 9 7
D72 DH73 M 300 3264619 9.19 41 50 0.82 52 135 0.39 147 66 2.23 12 12 10
D73 DH74 S 100 2959918 3.38 22 29 0.76 36 45 0.80 83 31 2.68 12 10 8
D74 DH75 M 281 1900661 14.78 16 50 0.32 40 135 0.30 15 66 0.23 13 11 8
D75 DH76 S 98 4261566 2.30 18 29 0.62 65 45 1.44 101 31 3.26 11 9 5
D76 DH77 S 135 3951862 3.42 24 34 0.71 29 90 0.32 41 42 0.98 12 12 9
D77 DH78 S 83 636342 13.04 23 29 0.79 31 45 0.69 51 31 1.65 11 9 8
D78 DH79 S 76 656246 11.58 15 29 0.52 12 45 0.27 12 31 0.39 11 7 4
D79 DH80 S 73 3423574 2.13 12 29 0.41 27 45 0.60 21 31 0.68 14 9 7

Annexures
129
130
Total Total Total
Annexures
D80 DH81 S 100 3330464 3.00 19 29 0.66 22 45 0.49 48 31 1.55 12 11 8
D81 DH82 S 84 2229076 3.77 20 29 0.69 28 45 0.62 36 31 1.16 11 11 8

D82 DH83 S 136 3495021 3.89 35 34 1.03 29 90 0.32 32 42 0.76 12 12 10
D83 DH84 L 470 3935042 11.94 23 68 0.34 29 225 0.13 41 100 0.41 12 13 8
D84 DH85 L 598 1055450 56.66 94 68 1.38 249 225 1.11 178 100 1.78 12 13 12

D85 DH86 S 100 352700 28.35 22 29 0.76 15 45 0.33 6 31 0.19 11 11 8
D86 DH87 S 100 467697 21.38 12 29 0.41 17 45 0.38 6 31 0.19 11 11 10
D87 DH88 S 60 285481 21.02 11 29 0.38 16 45 0.36 8 31 0.26 13 8 8
D88 DH89 S 178 2663629 6.68 40 34 1.18 55 90 0.61 71 42 1.69 12 12 9
D89 DH90 S 175 533638 32.79 54 34 1.59 86 90 0.96 186 42 4.43 10 11 8
D90 DH91 M 225 799781 28.13 22 50 0.44 67 135 0.50 93 66 1.41 14 12 8
D91 DH92 L 410 3343872 12.26 48 68 0.71 118 225 0.52 131 100 1.31 10 11 8
D92 DH93 S 60 585494 10.25 12 29 0.41 12 45 0.27 54 31 1.74 7 6 5
D93 DH94 S 93 1619707 5.74 28 29 0.97 43 45 0.96 64 31 2.06 11 10 8
D94 DH95 S 126 851669 14.79 20 34 0.59 36 90 0.40 15 42 0.36 13 12 11
D95 DH96 S 160 748941 21.36 21 34 0.62 24 90 0.27 16 42 0.38 13 13 9
D96 DH97 S 100 822526 12.16 21 29 0.72 38 45 0.84 79 31 2.55 12 11 7
D97 DH98 S 163 605073 26.94 20 34 0.59 25 90 0.28 79 42 1.88 11 8 7
D98 DH99 S 114 1206640 9.45 28 34 0.82 57 90 0.63 15 42 0.36 13 13 12
D99 DH100 S 165 1032754 15.98 22 34 0.65 50 90 0.56 14 42 0.33 10 12 9
D100 DH101 S 60 275036 21.82 13 29 0.45 16 45 0.36 24 31 0.77 11 7 7

Total Total Total
D101 DH102 S 100 139820 71.52 17 29 0.59 30 45 0.67 48 31 1.55 12 7 8
D102 DH103 S 100 4063872 2.46 48 29 1.66 74 45 1.64 53 31 1.71 11 12 10
D103 DH104 S 100 576702 17.34 19 29 0.66 39 45 0.87 63 31 2.03 10 7 8
D104 DH105 L 316 343709 91.94 68 58 1.17 153 180 0.85 345 81 4.26 14 14 14
D105 DH106 S 170 191173 88.92 27 34 0.79 58 90 0.64 21 42 0.50 14 12 10
D106 DH107 S 60 52074 115.22 13 29 0.45 20 45 0.44 9 31 0.29 14 7 6
D107 DH108 S 147 123344.4 119.18 111 34 3.26 84 90 0.93 166 42 3.95 12 12 10
D107 DH109 S 97 81390.55 119.18 28 29 0.97 44 45 0.98 116 31 3.74 11 6 7
D107 DH110 L 450 377585 119.18 254 68 3.74 140 225 0.62 199 100 1.99 13 11 12
D108 DH111 S 188 1709346 11.00 163 34 4.79 117 90 1.30 253 42 6.02 10 13 11
D109 DH112 S 100 197328.4 50.68 131 29 4.52 113 45 2.51 105 31 3.39 9 12 11
D109 DH113 S 150 295992.7 50.68 34 34 1.00 105 90 1.17 50 42 1.19 9 13 13
D109 DH114 S 200 394656.9 50.68 88 34 2.59 124 90 1.38 250 42 5.95 8 11 8
D110 DH115 M 222 2241624 9.90 117 50 2.34 115 135 0.85 186 66 2.82 11 12 11
D111 DH116 S 200 886433.7 22.56 36 34 1.06 109 90 1.21 38 42 0.90 9 12 11
D111 DH117 M 300 1329651 22.56 58 50 1.16 239 135 1.77 108 66 1.64 13 14 12
D111 DH118 L 325 1440455 22.56 132 58 2.28 130 180 0.72 54 81 0.67 10 13 11
D112 DH119 S 103 2731929 3.77 31 34 0.91 89 90 0.99 63 42 1.50 12 13 14
D113 DH120 S 100 2292958 4.36 91 29 3.14 95 45 2.11 41 31 1.32 11 12 13
D114 DH121 S 100 276439.5 36.17 31 29 1.07 106 45 2.36 155 31 5.00 8 13 12
D114 DH122 S 180 497591 36.17 108 34 3.18 99 90 1.10 149 42 3.55 13 12 9

Annexures
131
132
Total Total Total
Annexures
D114 DH123 L 640 1769213 36.17 130 68 1.91 647 225 2.88 832 100 8.32 9 13 13
D115 DH124 S 200 113309.1 176.51 128 34 3.76 140 90 1.56 61 42 1.45 10 13 11

D115 DH125 L 370 209621.9 176.51 198 58 3.41 175 180 0.97 246 81 3.04 12 13 13
D116 DH126 M 235 818008 28.73 74 50 1.48 147 135 1.09 290 66 4.39 14 13 13
D117 DH127 M 230 640537 35.91 66 50 1.32 143 135 1.06 57 66 0.86 12 14 13

D118 DH128 M 220 1514190 14.53 11 50 0.22 55 135 0.41 14 66 0.21 13 14 12
D119 DH129 S 119 2092745 5.69 13 34 0.38 33 90 0.37 13 42 0.31 13 10 11
D120 DH130 L 320 728535 43.92 37 58 0.64 84 180 0.47 44 81 0.54 13 12 12
D121 DH131 M 210 1551019 13.54 31 50 0.62 62 135 0.46 31 66 0.47 9 13 11
D122 DH132 S 64 652000 9.82 5 29 0.17 25 45 0.56 5 31 0.16 9 9 6
D123 DH133 S 100 1070000 9.35 14 29 0.48 27 45 0.60 5 31 0.16 12 9 8
D124 DH134 L 363 2127086 17.07 69 58 1.19 43 180 0.24 21 81 0.26 13 14 14
D125 DH135 S 150 752484 19.93 13 34 0.38 40 90 0.44 9 42 0.21 14 11 12
D126 DH136 S 160 2299885 6.96 30 34 0.88 42 90 0.47 30 42 0.71 12 13 10
D127 DH137 M 214 2035064 10.52 32 50 0.64 74 135 0.55 32 66 0.48 14 13 11
D128 DH138 S 50 994624 5.03 5 29 0.17 27 45 0.60 55 31 1.77 8 5 7
D129 DH139 M 206 960329 21.45 19 50 0.38 48 135 0.36 16 66 0.24 8 8 10
D130 DH140 S 81 590297 13.72 16 29 0.55 34 45 0.76 9 31 0.29 13 11 10
D131 DH141 M 230 1329672 17.30 29 50 0.58 72 135 0.53 22 66 0.33 13 13 11
D132 DH142 M 264 2390776 11.04 21 50 0.42 76 135 0.56 18 66 0.27 14 14 14
D133 DH143 M 241 585449 41.16 33 50 0.66 90 135 0.67 46 66 0.70 12 11 12

Total Total Total
D134 DH144 S 115 3804558 3.02 24 34 0.71 39 90 0.43 78 42 1.86 11 9 11
D135 DH145 S 110 1756268 6.26 17 34 0.50 73 90 0.81 30 42 0.71 11 8 11
D136 DH146 M 235 807022 29.12 29 50 0.58 148 135 1.10 23 66 0.35 10 14 12
D137 DH147 S 200 228291 87.61 23 34 0.68 43 90 0.48 126 42 3.00 12 14 12
D138 DH148 S 200 4165626 4.80 13 34 0.38 50 90 0.56 15 42 0.36 11 10 12
D139 DH149 S 200 1128350 17.72 72 34 2.12 34 90 0.38 80 42 1.90 13 12 11
D140 DH150 M 300 1634445 18.35 42 50 0.84 116 135 0.86 26 66 0.39 14 11 11
D141 DH151 S 200 1809733 11.05 48 34 1.41 61 90 0.68 22 42 0.52 12 12 8
D142 DH152 S 100 942011 10.62 22 29 0.76 51 45 1.13 29 31 0.94 13 11 8
D143 DH153 S 176 1743931 10.09 47 34 1.38 93 90 1.03 202 42 4.81 14 12 11
D144 DH154 S 100 958405 10.43 54 29 1.86 52 45 1.16 182 31 5.87 13 13 10
D145 DH155 S 90 1334152 6.75 35 29 1.21 31 45 0.69 28 31 0.90 8 10 10
D146 DH156 S 175 1074304 16.29 36 34 1.06 64 90 0.71 201 42 4.79 14 11 7
D147 DH157 S 92 964655 9.54 41 29 1.41 62 45 1.38 96 31 3.10 14 13 9
D148 DH158 S 100 922088 10.84 36 29 1.24 41 45 0.91 19 31 0.61 13 8 8
D149 DH159 S 48 1089263 4.41 47 29 1.62 24 45 0.53 46 31 1.48 12 11 9
D150 DH160 S 100 1042708 9.59 44 29 1.52 31 45 0.69 46 31 1.48 13 10 8
D151 DH161 M 300 561293 53.45 51 50 1.02 154 135 1.14 244 66 3.70 14 13 12
D152 DH162 S 83 1205437 6.89 47 29 1.62 51 45 1.13 73 31 2.35 8 13 10
D153 DH163 S 109 900332 12.11 62 34 1.82 48 90 0.53 151 42 3.60 10 12 11
D154 DH164 S 100 1061204 9.42 55 29 1.90 53 45 1.18 264 31 8.52 14 13 11

Annexures
133
134
Total Total Total
Annexures
D155 DH165 S 120 1295189 9.27 47 34 1.38 37 90 0.41 20 42 0.48 12 12 12
D156 DH166 S 200 1450001 13.79 47 34 1.38 57 90 0.63 24 42 0.57 14 12 10

D157 DH167 M 270 381956 70.69 20 50 0.40 35 135 0.26 138 66 2.09 12 14 8
D158 DH168 M 300 519080 57.79 8 50 0.16 31 135 0.23 15 66 0.23 9 11 11
D159 DH169 M 216 454768 47.50 25 50 0.50 38 135 0.28 35 66 0.53 10 12 11

D160 DH170 M 215 1510075 14.24 26 50 0.52 49 135 0.36 112 66 1.70 11 12 9
D161 DH171 M 300 437903 68.51 28 50 0.56 54 135 0.40 96 66 1.45 11 13 8
D162 DH172 S 20 31564 63.36 7 29 0.24 6 45 0.13 17 31 0.55 10 10 9
D163 DH173 M 300 999777 30.01 25 50 0.50 13 135 0.10 46 66 0.70 11 14 12
D164 DH174 M 261 814010 32.06 39 50 0.78 39 135 0.29 31 66 0.47 13 13 9
D165 DH175 M 250 529855 47.18 67 50 1.34 95 135 0.70 137 66 2.08 12 14 11
D166 DH176 S 180 580320 31.02 22 34 0.65 36 90 0.40 76 42 1.81 12 13 8
D167 DH177 S 200 521173 38.37 18 34 0.53 36 90 0.40 25 42 0.60 11 13 9
D168 DH178 S 110 412000.4 26.70 20 34 0.59 23 90 0.26 45 42 1.07 10 5 4
D168 DH179 S 178 666691.6 26.70 67 34 1.97 29 90 0.32 126 42 3.00 13 10 10
D169 DH180 S 64 753745 8.49 50 29 1.72 7 45 0.16 25 31 0.81 12 11 9
D170 DH181 S 20 392232 5.10 23 29 0.79 17 45 0.38 37 31 1.19 13 9 9
D171 DH182 S 200 1008039 19.84 66 34 1.94 31 90 0.34 105 42 2.50 14 12 13
D172 DH183 S 160 409936 39.03 23 34 0.68 17 90 0.19 79 42 1.88 8 11 8
D173 DH184 S 40 297446 13.45 31 29 1.07 15 45 0.33 38 31 1.23 8 11 11
D174 DH185 S 135 843038.1 16.01 56 34 1.65 40 90 0.44 34 42 0.81 12 12 10

Total Total Total
D174 DH186 S 58 686919.9 8.44 38 29 1.31 14 45 0.31 27 31 0.87 9 10 9
D175 DH187 S 160 616435 25.96 28 34 0.82 33 90 0.37 73 42 1.74 11 11 8
D176 DH188 S 36 424483 8.48 36 29 1.24 18 45 0.40 40 31 1.29 10 12 9
D177 DH189 S 50 870354 5.74 38 29 1.31 23 45 0.51 50 31 1.61 9 10 9
D178 DH190 S 54 560440 9.64 55 29 1.90 20 45 0.44 49 31 1.58 14 12 10
D179 DH191 S 40 283713 14.10 17 29 0.59 11 45 0.24 48 31 1.55 8 11 9
D180 DH192 S 50 314667 15.89 11 29 0.38 8 45 0.18 35 31 1.13 8 11 8
D181 DH193 S 70 318898 21.95 23 29 0.79 10 45 0.22 31 31 1.00 9 12 8
D182 DH194 S 32 266215 12.02 22 29 0.76 14 45 0.31 45 31 1.45 9 10 9
D183 DH195 S 150 1236829 12.13 61 34 1.79 30 90 0.33 116 42 2.76 13 13 12
D184 DH196 S 200 554985 36.04 35 34 1.03 27 90 0.30 116 42 2.76 10 11 11
D185 DH197 S 100 2062330 4.85 22 29 0.76 8 45 0.18 24 31 0.77 3 7 10
D186 DH198 S 27 1042886 2.59 11 29 0.38 10 45 0.22 45 31 1.45 9 5 6
D187 DH199 S 100 1492073 6.70 24 29 0.83 12 45 0.27 8 31 0.26 9 12 8
D188 DH200 S 103 1321442 7.79 23 34 0.68 30 90 0.33 20 42 0.48 10 11 9
D189 DH201 S 100 1322784 7.56 20 29 0.69 9 45 0.20 26 31 0.84 11 10 8
D190 DH202 S 100 2445474 4.09 17 29 0.59 6 45 0.13 26 31 0.84 11 10 8
D191 DH203 S 100 1313551 7.61 17 29 0.59 6 45 0.13 35 31 1.13 5 9 7
D192 DH204 S 182 1025213 17.75 19 34 0.56 20 90 0.22 64 42 1.52 10 9 7
D193 DH205 L 326 1734495 18.80 22 58 0.38 12 180 0.07 44 81 0.54 10 12 9
D194 DH206 S 100 791042 12.64 12 29 0.41 8 45 0.18 38 31 1.23 9 9 11

Annexures
135
136
Total Total Total
Annexures
D195 DH207 S 60 531885 11.28 15 29 0.52 14 45 0.31 37 31 1.19 9 6 6
D196 DH208 S 100 716259 13.96 12 29 0.41 13 45 0.29 20 31 0.65 13 9 8

D197 DH209 S 60 726978 8.25 12 29 0.41 11 45 0.24 51 31 1.65 10 7 7
D198 DH210 S 50 461790 10.83 19 29 0.66 12 45 0.27 45 31 1.45 11 6 9
D199 DH211 S 100 900422 11.11 9 29 0.31 7 45 0.16 50 31 1.61 6 6 5

D200 DH212 S 200 1939869 10.31 25 34 0.74 16 90 0.18 74 42 1.76 11 12 8
D201 DH213 S 100 1502338 6.66 23 29 0.79 31 45 0.69 51 31 1.65 10 7 7
D202 DH214 S 100 2293919 4.36 20 29 0.69 11 45 0.24 101 31 3.26 9 9 10
D203 DH215 S 40 949443 4.21 19 29 0.66 2 45 0.04 31 31 1.00 8 10 8
D204 DH216 S 200 2914253 6.86 44 34 1.29 103 90 1.14 63 42 1.50 10 13 10
D205 DH217 S 60 1150567 5.21 15 29 0.52 0 45 0.00 0 31 0.00 10 7 8
D206 DH218 S 80 1065056 7.51 14 29 0.48 9 45 0.20 9 31 0.29 8 6 8
D207 DH219 S 100 599578 16.68 17 29 0.59 21 45 0.47 59 31 1.90 9 8 7
D208 DH220 M 300 1889752 15.88 19 50 0.38 56 135 0.41 16 66 0.24 12 14 11
D209 DH221 S 120 350405.5 34.25 11 34 0.32 36 90 0.40 75 42 1.79 13 5 5
D209 DH222 S 200 584009.2 34.25 44 34 1.29 71 90 0.79 28 42 0.67 7 11 9
D209 DH223 M 285 832213.1 34.25 53 50 1.06 93 135 0.69 25 66 0.38 13 14 11
D209 DH224 L 536 1565145 34.25 167 68 2.46 210 225 0.93 29 100 0.29 6 5 14
D209 DH225 L 764 2230915 34.25 285 68 4.19 233 225 1.04 68 100 0.68 10 9 11
D209 DH226 L 360 1051216 34.25 46 58 0.79 91 180 0.51 21 81 0.26 14 13 10
D209 DH227 L 1030 3007647 34.25 114 68 1.68 110 225 0.49 42 100 0.42 12 12 12
Total Total Total
D210 DH228 L 740 4779661 15.48 131 68 1.93 335 225 1.49 386 100 3.86 10 13 12
D211 DH229 M 210 2452595 8.56 43 50 0.86 65 135 0.48 208 66 3.15 9 12 10
D211 DH230 L 1017 2452595 41.47 170 68 2.50 170 225 0.76 63 100 0.63 11 13 14
D212 DH231 L 450 1703300 26.42 179 68 2.63 306 225 1.36 49 100 0.49 11 14 11
D213 DH232 M 250 2177331 11.48 17 50 0.34 71 135 0.53 41 66 0.62 12 13 9
D214 DH233 M 300 1020791 29.39 58 50 1.16 29 135 0.21 45 66 0.68 12 14 12
D215 DH234 S 140 1255104 11.15 29 34 0.85 16 90 0.18 34 42 0.81 9 12 9
D216 DH235 L 400 1137961 35.15 28 58 0.48 58 180 0.32 46 81 0.57 13 11 7
D217 DH236 L 450 1659456 27.12 33 68 0.49 94 225 0.42 112 100 1.12 14 13 11
D218 DH237 M 272 482909.5 56.33 33 50 0.66 78 135 0.58 185 66 2.80 14 5 7
D218 DH238 L 905 1606739 56.33 117 68 1.72 125 225 0.56 19 100 0.19 10 13 14
D219 DH239 S 100 1945497 5.14 8 29 0.28 46 45 1.02 42 31 1.35 5 4 5
D219 DH240 L 930 1945497 47.80 38 68 0.56 105 225 0.47 26 100 0.26 13 13 11
D220 DH241 M 250 318452.2 78.50 20 50 0.40 54 135 0.40 11 66 0.17 14 13 11
D220 DH242 L 1200 1528571 78.50 284 68 4.18 314 225 1.40 79 100 0.79 12 14 14
D221 DH243 M 250 1064570 23.48 9 50 0.18 35 135 0.26 65 66 0.98 10 9 7
D222 DH244 L 560 2566326 21.82 106 68 1.56 154 225 0.68 60 100 0.60 14 14 13
D223 DH245 L 750 1776421 42.22 176 68 2.59 324 225 1.44 54 100 0.54 14 14 14
D224 DH246 M 300 1597668 18.78 31 50 0.62 27 135 0.20 45 66 0.68 12 13 11
D225 DH247 L 410 554519 73.94 80 68 1.18 144 225 0.64 282 100 2.82 12 14 12
D226 DH248 L 400 1536401 26.03 43 58 0.74 59 180 0.33 26 81 0.32 12 14 11

Annexures
D227 DH249 M 300 1389920 21.58 8 50 0.16 11 135 0.08 9 66 0.14 14 13 11
137
138
Total Total Total
Annexures
D228 DH250 L 650 1805769 36.00 197 68 2.90 290 225 1.29 61 100 0.61 14 14 13
D229 DH251 L 410 860463 47.65 83 68 1.22 86 225 0.38 13 100 0.13 9 4 5

D229 DH252 L 1020 2140664 47.65 45 68 0.66 49 225 0.22 85 100 0.85 12 11 12
D230 DH253 L 640 1928812 33.18 124 68 1.82 266 225 1.18 77 100 0.77 13 14 12
D231 DH254 S 100 1082636 9.24 16 29 0.55 14 45 0.31 23 31 0.74 11 10 8

D232 DH255 L 950 1752753 54.20 148 68 2.18 261 225 1.16 654 100 6.54 14 14 14
D233 DH256 L 400 2678980 14.93 43 58 0.74 80 180 0.44 26 81 0.32 13 14 13
D234 DH257 M 250 1177361 21.23 28 50 0.56 25 135 0.19 18 66 0.27 12 13 11
D235 DH258 L 316 1437169 21.99 9 58 0.16 55 180 0.31 7 81 0.09 12 14 12
D236 DH259 S 100 1174271 8.52 19 29 0.66 21 45 0.47 48 31 1.55 9 10 9
D237 DH260 M 255 2127789 11.98 24 50 0.48 65 135 0.48 14 66 0.21 10 5 5
D237 DH261 L 400 2127789 18.80 54 58 0.93 78 180 0.43 69 81 0.85 8 12 11
D238 DH262 M 227 860395 26.38 32 50 0.64 46 135 0.34 34 66 0.52 11 14 9
D238 DH263 L 639 2421993 26.38 91 68 1.34 394 225 1.75 602 100 6.02 14 14 12
D239 DH264 S 144 1108974 12.98 32 34 0.94 42 90 0.47 14 42 0.33 9 13 9
D240 DH265 L 541 2523003 21.44 56 68 0.82 119 225 0.53 62 100 0.62 9 14 9
D241 DH266 L 364 1307375 27.84 52 58 0.90 94 180 0.52 39 81 0.48 10 14 9
D242 DH267 M 273 2635375 10.36 31 50 0.62 98 135 0.73 16 66 0.24 7 5 5
D242 DH268 L 537 2635375 20.38 63 68 0.93 149 225 0.66 44 100 0.44 11 11 9
D243 DH269 L 360 1974551 18.23 61 58 1.05 113 180 0.63 45 81 0.56 11 13 8
D244 DH270 L 525 3086293 17.01 60 68 0.88 124 225 0.55 35 100 0.35 10 14 12
Total Total Total
D245 DH271 S 164 4112920 3.99 34 34 1.00 31 90 0.34 49 42 1.17 10 14 11
D245 DH272 L 501 4112920 12.18 48 68 0.71 106 225 0.47 21 100 0.21 11 14 10
D246 DH273 M 250 2809934 8.90 21 50 0.42 61 135 0.45 24 66 0.36 13 4 5
D246 DH274 L 544 2809934 19.36 47 68 0.69 117 225 0.52 234 100 2.34 13 11 13
D247 DH275 L 403 1197412 33.66 55 68 0.81 56 225 0.25 21 100 0.21 12 14 9
D248 DH276 M 300 671476.7 44.68 54 50 1.08 65 135 0.48 34 66 0.52 10 12 10
D248 DH277 L 747 1671977 44.68 77 68 1.13 214 225 0.95 367 100 3.67 10 11 10
D248 DH278 L 428 957973.4 44.68 38 68 0.56 137 225 0.61 244 100 2.44 10 6 8
D249 DH279 M 240 3121200 7.69 48 50 0.96 80 135 0.59 169 66 2.56 10 14 13
D250 DH280 M 296 817420 36.21 63 50 1.26 73 135 0.54 208 66 3.15 10 14 10
D251 DH281 S 160 140802 113.63 34 34 1.00 62 90 0.69 199 42 4.74 8 13 11
D252 DH282 M 250 133487 187.28 38 50 0.76 57 135 0.42 190 66 2.88 9 13 12
D253 DH283 S 50 64473 77.55 21 29 0.72 21 45 0.47 30 31 0.97 3 3 8
D254 DH284 S 100 571278 17.50 22 29 0.76 54 45 1.20 14 31 0.45 12 9 9
D255 DH285 S 110 728999 15.09 34 34 1.00 56 90 0.62 80 42 1.90 12 9 5
D256 DH286 S 100 749237 13.35 20 29 0.69 51 45 1.13 16 31 0.52 12 9 9
D257 DH287 S 100 845071 11.83 27 29 0.93 54 45 1.20 12 31 0.39 11 11 10
D258 DH288 M 300 1701698 17.63 31 50 0.62 136 135 1.01 211 66 3.20 11 12 8
D259 DH289 M 300 1385881 21.65 35 50 0.70 103 135 0.76 195 66 2.95 10 12 5
D260 DH290 M 300 1575362 19.04 28 50 0.56 138 135 1.02 36 66 0.55 13 11 11
D261 DH291 L 350 1703005 20.55 50 58 0.86 82 180 0.46 30 81 0.37 13 12 10

Annexures
139
140
Total Total Total
Annexures
D262 DH292 L 330 2371061 13.92 76 58 1.31 158 180 0.88 87 81 1.07 11 12 9
D263 DH293 S 200 757847 26.39 23 34 0.68 71 90 0.79 25 42 0.60 12 9 8

D264 DH294 M 300 1762375 17.02 57 50 1.14 92 135 0.68 131 66 1.98 13 11 8
D265 DH295 L 400 2090922 19.13 53 58 0.91 154 180 0.86 163 81 2.01 13 13 11
D266 DH296 M 300 1264219 23.73 32 50 0.64 92 135 0.68 25 66 0.38 12 11 9

D267 DH297 L 350 786754 44.49 44 58 0.76 48 180 0.27 86 81 1.06 12 11 10
D268 DH298 L 400 1563715 25.58 43 58 0.74 140 180 0.78 204 81 2.52 13 13 9
D269 DH299 M 300 2185793 13.72 46 50 0.92 108 135 0.80 161 66 2.44 11 12 9
D270 DH300 S 100 704524 14.19 21 29 0.72 66 45 1.47 85 31 2.74 9 10 10
D271 DH301 L 400 1241519 32.22 35 58 0.60 108 180 0.60 154 81 1.90 11 13 9
D272 DH302 S 200 2032036 9.84 45 34 1.32 81 90 0.90 128 42 3.05 13 12 9
D273 DH303 S 100 570465 17.53 31 29 1.07 58 45 1.29 39 31 1.26 14 13 10
D274 DH304 M 300 1241350 24.17 38 50 0.76 117 135 0.87 208 66 3.15 12 11 12
D275 DH305 S 100 3276697 3.05 37 29 1.28 63 45 1.40 22 31 0.71 10 11 9
D276 DH306 L 500 2463289 20.30 48 68 0.71 224 225 1.00 306 100 3.06 11 11 10
D277 DH307 S 200 1025048 19.51 27 34 0.79 69 90 0.77 31 42 0.74 14 12 9
D278 DH308 S 200 1292042 15.48 24 34 0.71 85 90 0.94 73 42 1.74 10 13 9
D279 DH309 L 400 1310061 30.53 28 58 0.48 115 180 0.64 64 81 0.79 9 12 10
D280 DH310 M 300 1873046 16.02 41 50 0.82 104 135 0.77 45 66 0.68 10 12 10
D281 DH311 M 300 1054905 28.44 25 50 0.50 132 135 0.98 114 66 1.73 13 13 10
D282 DH312 L 500 1340411 37.30 34 68 0.50 165 225 0.73 22 100 0.22 11 13 11
Total Total Total
D283 DH313 M 300 1965970 15.26 42 50 0.84 114 135 0.84 126 66 1.91 13 13 11
D284 DH314 M 300 1091854 27.48 22 50 0.44 116 135 0.86 139 66 2.11 13 12 8
D285 DH315 S 200 826067 24.21 28 34 0.82 46 90 0.51 81 42 1.93 13 12 9
D286 DH316 S 200 1016520 19.67 21 34 0.62 74 90 0.82 173 42 4.12 11 10 9
D287 DH317 S 200 1331597 15.02 32 34 0.94 70 90 0.78 98 42 2.33 11 12 11
D288 DH318 M 300 1545814 19.41 21 50 0.42 86 135 0.64 115 66 1.74 12 12 10
D289 DH319 L 500 1455069 34.36 45 68 0.66 170 225 0.76 52 100 0.52 13 12 10
D290 DH320 S 100 2365106 4.23 35 29 1.21 67 45 1.49 91 31 2.94 12 13 10
D291 DH321 M 300 2378458 12.61 37 50 0.74 146 135 1.08 257 66 3.89 9 12 10
D292 DH322 L 400 2228935 17.95 50 58 0.86 152 180 0.84 268 81 3.31 14 14 12
D293 DH323 M 240 1311332 18.30 29 50 0.58 102 135 0.76 105 66 1.59 11 12 13
D294 DH324 L 400 1379131 29.00 27 58 0.47 168 180 0.93 36 81 0.44 13 10 6
D295 DH325 M 300 1066063 28.14 38 50 0.76 99 135 0.73 159 66 2.41 13 12 10
D296 DH326 S 200 1512681 13.22 20 34 0.59 68 90 0.76 109 42 2.60 12 11 9
D297 DH327 S 100 687861 14.54 31 29 1.07 53 45 1.18 56 31 1.81 13 11 9
D298 DH328 M 300 1726050 17.38 45 50 0.90 87 135 0.64 117 66 1.77 13 11 9
D299 DH329 M 300 1127033 26.62 26 50 0.52 121 135 0.90 43 66 0.65 10 10 8
D300 DH330 S 120 1178273 10.18 24 34 0.71 81 90 0.90 21 42 0.50 9 8 7
D301 DH331 S 200 1445166 13.84 27 34 0.79 98 90 1.09 192 42 4.57 14 10 10
D302 DH332 L 700 1986864 35.23 54 68 0.79 245 225 1.09 315 100 3.15 12 12 10
D303 DH333 S 100 644758 15.51 18 29 0.62 42 45 0.93 57 31 1.84 10 10 7

Annexures
141
142
Total Total Total
Annexures
D304 DH334 M 300 1458875 20.56 39 50 0.78 87 135 0.64 144 66 2.18 10 11 8
D305 DH335 M 274 4543159 6.03 54 50 1.08 143 135 1.06 56 66 0.85 11 14 11

D306 DH336 L 379 1927325 19.66 50 58 0.86 155 180 0.86 51 81 0.63 14 11 9
D306 DH337 S 189 961119.9 19.66 34 34 1.00 59 90 0.66 26 42 0.62 8 4 5
D307 DH338 L 320 2585049 12.38 62 58 1.07 136 180 0.76 220 81 2.72 11 14 11

D308 DH339 L 482 1200334 40.16 61 68 0.90 142 225 0.63 222 100 2.22 10 13 11
D309 DH340 L 306 2586258 11.83 71 58 1.22 158 180 0.88 225 81 2.78 11 12 9
D310 DH341 M 252 1072942 23.49 33 50 0.66 120 135 0.89 22 66 0.33 11 12 14
D311 DH342 S 100 1177345 8.49 52 29 1.79 89 45 1.98 47 31 1.52 13 11 7
D312 DH343 L 356 4229917 8.42 25 58 0.43 166 180 0.92 217 81 2.68 10 13 9
D313 DH344 S 60 452087.5 13.27 18 29 0.62 34 45 0.76 20 31 0.65 8 3 6
D313 DH345 S 200 1506958 13.27 47 34 1.38 110 90 1.22 220 42 5.24 11 11 9
D314 DH346 S 200 1648295 12.13 37 34 1.09 101 90 1.12 45 42 1.07 10 10 10
D315 DH347 L 541 6107187 8.86 66 68 0.97 203 225 0.90 379 100 3.79 11 14 11
D316 DH348 M 236 1657576 14.24 42 50 0.84 147 135 1.09 155 66 2.35 11 13 10
D316 DH349 S 60 1657576 3.62 16 29 0.55 33 45 0.73 56 31 1.81 9 6 9
D317 DH350 L 406 1836086 22.11 44 68 0.65 130 225 0.58 29 100 0.29 11 12 11
D317 DH351 S 60 1836086 3.27 7 29 0.24 19 45 0.42 4 31 0.13 9 6 7
D318 DH352 L 333 9429408 3.53 80 58 1.38 159 180 0.88 347 81 4.28 11 14 12
D319 DH353 M 272 2634200 10.33 47 50 0.94 88 135 0.65 42 66 0.64 14 14 10
D320 DH354 S 200 1615069 12.38 35 34 1.03 111 90 1.23 32 42 0.76 11 14 12

Total Total Total
D321 DH355 M 242 3003741 8.06 41 50 0.82 123 135 0.91 — — — 11 14 11
D322 DH356 S 200 849651 23.54 40 34 1.18 99 90 1.10 24 42 0.57 10 12 9
D323 DH357 M 278 11060148 2.51 40 50 0.80 129 135 0.96 256 66 3.88 11 14 9
D324 DH358 M 282 1300774 21.68 50 50 1.00 95 135 0.70 70 66 1.06 10 13 12
D325 DH359 S 200 1197160 16.71 28 34 0.82 72 90 0.80 109 42 2.60 11 11 8
D326 DH360 S 50 237399 21.06 39 29 1.34 25 45 0.56 92 31 2.97 9 10 10
D327 DH361 S 29 144182 20.11 28 29 0.97 30 45 0.67 80 31 2.58 8 7 6
D328 DH362 S 141 274143 51.43 72 34 2.12 51 90 0.57 281 42 6.69 11 10 8
D329 DH363 S 50 479148 10.44 17 29 0.59 24 45 0.53 76 31 2.45 8 7 7
D330 DH364 S 36 140651 25.60 11 29 0.38 19 45 0.42 53 31 1.71 9 6 8
D331 DH365 S 64 422168 15.16 59 29 2.03 57 45 1.27 119 31 3.84 11 12 9
D332 DH366 S 50 183998 27.17 21 29 0.72 33 45 0.73 68 31 2.19 9 6 7
D333 DH367 S 100 317917 31.45 13 29 0.45 39 45 0.87 14 31 0.45 9 6 3
D334 DH368 L 386 323332.5 119.38 53 58 0.91 134 180 0.74 63 81 0.78 12 9 8
D334 DH369 L 600 502589.5 119.38 62 68 0.91 142 225 0.63 67 100 0.67 9 11 12
D335 DH370 S 74 258840 28.59 17 29 0.59 31 45 0.69 35 31 1.13 10 8 8
D336 DH371 S 50 643291 7.77 19 29 0.66 46 45 1.02 6 31 0.19 8 5 4
D336 DH372 S 200 643291 31.09 50 34 1.47 52 90 0.58 27 42 0.64 10 11 8
D337 DH373 S 108 395124 27.33 23 34 0.68 53 90 0.59 46 42 1.10 10 11 8
D338 DH374 S 100 191730.5 52.16 20 29 0.69 28 45 0.62 30 31 0.97 9 10 9
D338 DH375 S 100 191730.5 52.16 12 29 0.41 36 45 0.80 15 31 0.48 9 8 7

Annexures
143
144
Total Total Total
Annexures
D339 DH376 M 280 400309 69.95 83 50 1.66 178 135 1.32 393 66 5.95 14 14 14
D340 DH377 S 73 125745 58.05 14 29 0.48 21 45 0.47 64 31 2.06 9 9 10

D341 DH378 S 60 83955 71.47 10 29 0.34 19 45 0.42 55 31 1.77 9 8 8
D342 DH379 S 34 117894 28.84 12 29 0.41 15 45 0.33 58 31 1.87 9 7 9

D343 DH380 S 143 161428 88.58 31 34 0.91 65 90 0.72 149 42 3.55 10 13 12
D344 DH381 S 26 86364 30.11 10 29 0.34 11 45 0.24 39 31 1.26 8 8 9
D345 DH382 S 45 56574 79.54 11 29 0.38 23 45 0.51 64 31 2.06 9 7 7
D346 DH383 S 51 64937 78.54 14 29 0.48 19 45 0.42 67 31 2.16 8 10 12
D347 DH384 S 150 378811 39.60 36 34 1.06 54 90 0.60 67 42 1.60 9 11 9
D348 DH385 S 150 194622 77.07 18 34 0.53 42 90 0.47 150 42 3.57 9 11 10
D349 DH386 S 50 166343 30.06 14 29 0.48 15 45 0.33 55 31 1.77 7 8 6
D350 DH387 S 163 1273821 12.80 31 34 0.91 42 90 0.47 13 42 0.31 10 13 9
D351 DH388 M 236 1648997 14.31 113 50 2.26 61 135 0.45 156 66 2.36 14 14 11
D352 DH389 L 360 2320529 15.51 73 58 1.26 95 180 0.53 33 81 0.41 14 14 11
D353 DH390 S 160 1481255 10.80 22 34 0.65 49 90 0.54 62 42 1.48 12 9 8
D354 DH391 S 93 441162 21.08 28 29 0.97 17 45 0.38 38 31 1.23 8 7 5
D355 DH392 M 269 1506337 17.86 38 50 0.76 54 135 0.40 17 66 0.26 12 13 11
D356 DH393 S 130 2624470 4.95 33 34 0.97 31 90 0.34 22 42 0.52 11 8 8
D357 DH394 S 128 312520 40.96 16 34 0.47 35 90 0.39 54 42 1.29 11 9 9
D358 DH395 M 288 1192811 24.14 29 50 0.58 41 135 0.30 69 66 1.05 11 11 8
D359 DH396 S 111 577817 19.21 25 34 0.74 28 90 0.31 88 42 2.10 11 11 10

Total Total Total
D360 DH397 S 137 3529031 3.88 33 34 0.97 36 90 0.40 119 42 2.83 11 13 10
D361 DH398 S 126 1136971 11.08 25 34 0.74 38 90 0.42 33 42 0.79 11 13 8
D362 DH399 L 305 1827192 16.69 30 58 0.52 90 180 0.50 44 81 0.54 10 12 8
D363 DH400 S 116 579505 20.02 25 34 0.74 43 90 0.48 53 42 1.26 10 12 8
D364 DH401 S 165 1576869 10.46 33 34 0.97 55 90 0.61 17 42 0.40 11 13 11
D365 DH402 S 186 733110 25.37 39 34 1.15 49 90 0.54 178 42 4.24 11 13 10
D366 DH403 S 195 1440361 13.54 25 34 0.74 32 90 0.36 13 42 0.31 14 13 8
D367 DH404 S 162 405272 39.97 40 34 1.18 65 90 0.72 103 42 2.45 10 13 10
D368 DH405 L 675 1851254 36.46 129 68 1.90 179 225 0.80 221 100 2.21 12 14 12
D368 DH406 S 146 400419.3 36.46 43 34 1.26 45 90 0.50 43 42 1.02 10 13 9
D369 DH407 S 195 1379647 14.13 34 34 1.00 61 90 0.68 94 42 2.24 9 7 11
D370 DH408 S 125 613192 20.39 32 34 0.94 54 90 0.60 90 42 2.14 9 11 9
D371 DH409 M 255 2519738 10.12 107 50 2.14 86 135 0.64 118 66 1.79 12 14 11
D372 DH410 S 135 1220946 11.06 24 34 0.71 46 90 0.51 69 42 1.64 6 7 7
D373 DH411 S 168 962789 17.45 20 34 0.59 34 90 0.38 25 42 0.60 13 11 8
D374 DH412 S 120 610382 19.66 16 34 0.47 50 90 0.56 69 42 1.64 6 11 9
D375 DH413 L 380 1698730 22.37 50 58 0.86 66 180 0.37 35 81 0.43 10 14 11
D376 DH414 S 99 967911 10.23 24 29 0.83 63 45 1.40 89 31 2.87 5 8 7
D377 DH415 M 225 1041099 21.61 33 50 0.66 37 135 0.27 44 66 0.67 9 12 10
D378 DH416 S 110 80775 136.18 19 34 0.56 22 90 0.24 32 42 0.76 7 5 6

Annexures
D379 DH417 L 313 2093437 14.95 44 58 0.76 82 180 0.46 27 81 0.33 9 10 6
145
146
Total Total Total
Annexures
D379 DH418 S 197 2093437 9.41 28 34 0.82 53 90 0.59 79 42 1.88 10 10 9
D380 DH419 L 506 200222 252.72 58 68 0.85 166 225 0.74 562 100 5.62 10 14 11

D381 DH420 S 171 41816 408.93 19 34 0.56 74 90 0.82 105 42 2.50 9 14 9
D382 DH421 L 450 950289 47.35 88 68 1.29 199 225 0.88 149 100 1.49 9 6 8

D383 DH422 S 100 55626 179.77 29 29 1.00 61 45 1.36 62 31 2.00 9 11 9
D384 DH423 S 200 2490656 8.03 37 34 1.09 98 90 1.09 189 42 4.50 11 12 10
D385 DH424 S 160 595527 26.87 28 34 0.82 53 90 0.59 98 42 2.33 10 12 12
D386 DH425 S 200 1388525 14.40 49 34 1.44 59 90 0.66 133 42 3.17 10 13 12
D387 DH426 S 100 617508 16.19 31 29 1.07 44 45 0.98 87 31 2.81 11 11 10
D388 DH427 S 80 118100 67.74 32 29 1.10 42 45 0.93 25 31 0.81 10 12 12
D389 DH428 S 75 1180483 6.35 14 29 0.48 23 45 0.51 34 31 1.10 11 10 10
D390 DH429 S 120 2029074 5.91 27 34 0.79 56 90 0.62 54 42 1.29 11 11 11
D391 DH430 S 104 2298323 4.53 28 34 0.82 50 90 0.56 69 42 1.64 10 10 11
D392 DH431 S 200 1586625 12.61 32 34 0.94 59 90 0.66 21 42 0.50 9 13 12
D393 DH432 L 470 2193590 21.43 76 68 1.12 120 225 0.53 29 100 0.29 10 14 12
D394 DH433 S 120 815168 14.72 30 34 0.88 40 90 0.44 109 42 2.60 11 13 11
D395 DH434 M 270 3498739 7.72 46 50 0.92 58 135 0.43 37 66 0.56 9 13 13
D396 DH435 S 100 769751 12.99 26 29 0.90 42 45 0.93 140 31 4.52 10 13 12
D397 DH436 S 120 995746 12.05 25 34 0.74 77 90 0.86 57 42 1.36 10 12 11
D398 DH437 S 200 994628 20.11 37 34 1.09 64 90 0.71 145 42 3.45 11 12 12
D399 DH438 S 100 901896 11.09 16 29 0.55 40 45 0.89 111 31 3.58 11 8 10

Total Total Total
D400 DH439 S 100 129500 77.22 22 29 0.76 40 45 0.89 85 31 2.74 10 13 11
D401 DH440 S 150 626154 23.96 34 34 1.00 60 90 0.67 88 42 2.10 10 12 11
D402 DH441 S 200 1895686 10.55 42 34 1.24 60 90 0.67 48 42 1.14 9 12 8
D403 DH442 S 100 684627 14.61 31 29 1.07 42 45 0.93 133 31 4.29 9 13 11
D404 DH443 S 100 1655169 6.04 29 29 1.00 45 45 1.00 61 31 1.97 10 13 12
D405 DH444 S 100 1119627 8.93 25 29 0.86 40 45 0.89 81 31 2.61 9 12 10
D406 DH445 L 400 2583052 15.49 33 58 0.57 105 180 0.58 151 81 1.86 14 13 12
D407 DH446 L 701 3674179 19.08 79 68 1.16 147 225 0.65 153 100 1.53 13 13 11
D408 DH447 L 454 1797485 25.26 57 68 0.84 169 225 0.75 17 100 0.17 12 13 12
D409 DH448 L 333 1222755 27.23 53 58 0.91 108 180 0.60 27 81 0.33 13 13 9
D410 DH449 M 285 2603751 10.95 43 50 0.86 83 135 0.61 106 66 1.61 13 13 11
D411 DH450 L 525 2548462 20.60 60 68 0.88 121 225 0.54 130 100 1.30 12 14 10
D412 DH451 L 525 2408523 21.80 54 68 0.79 186 225 0.83 223 100 2.23 12 13 14
D413 DH452 M 300 1110906 27.00 58 50 1.16 103 135 0.76 170 66 2.58 12 13 9
D414 DH453 L 551 1544338 35.68 48 68 0.71 119 225 0.53 55 100 0.55 14 13 8
D415 DH454 M 300 2039547 14.71 55 50 1.10 84 135 0.62 170 66 2.58 14 14 13
D416 DH455 M 250 1634409 15.30 50 50 1.00 72 135 0.53 40 66 0.61 14 11 10
D417 DH456 L 400 1206516 33.15 44 58 0.76 128 180 0.71 154 81 1.90 14 13 11
D418 DH457 M 256 1388552 18.44 30 50 0.60 97 135 0.72 9 66 0.14 13 13 8
D419 DH458 L 370 1969168 18.79 68 58 1.17 129 180 0.72 316 81 3.90 14 14 10

Annexures
D420 DH459 L 307 1774692 17.30 45 58 0.78 90 180 0.50 246 81 3.04 14 14 10
147
148
Total Total Total
Annexures
D421 DH460 S 150 669919 22.39 32 34 0.94 26 90 0.29 52 42 1.24 14 13 12
D422 DH461 S 150 1828730 8.20 57 34 1.68 60 90 0.67 59 42 1.40 10 11 9

D423 DH462 S 200 2137045 9.36 60 34 1.76 73 90 0.81 49 42 1.17 14 14 11
D424 DH463 M 300 1458248 20.57 39 50 0.78 78 135 0.58 65 66 0.98 13 14 8

D425 DH464 M 296 3307743 8.95 30 50 0.60 84 135 0.62 78 66 1.18 12 12 6
D426 DH465 L 307 2037573 15.07 38 58 0.66 113 180 0.63 153 81 1.89 13 13 10
D427 DH466 S 150 867848 17.28 28 34 0.82 96 90 1.07 11 42 0.26 13 12 10
D428 DH467 M 220 1156597 19.02 27 50 0.54 64 135 0.47 14 66 0.21 14 14 9
D429 DH468 M 294 1335551 22.01 64 50 1.28 117 135 0.87 66 66 1.00 13 13 7
D430 DH469 L 400 2677333 14.94 72 58 1.24 127 180 0.71 185 81 2.28 13 14 11
D431 DH470 S 200 1036346 19.30 28 34 0.82 75 90 0.83 100 42 2.38 10 12 10
D432 DH471 S 200 1421326 14.07 44 34 1.29 117 90 1.30 153 42 3.64 13 14 11
D433 DH472 S 105 283583 37.03 31 34 0.91 26 90 0.29 96 42 2.29 9 11 11
D434 DH473 S 50 43709 114.39 17 29 0.59 23 45 0.51 57 31 1.84 9 5 8
D435 DH474 S 100 146850 68.10 34 29 1.17 20 45 0.44 44 31 1.42 13 12 9
D436 DH475 S 80 136435 58.64 16 29 0.55 28 45 0.62 66 31 2.13 10 10 11
D437 DH476 M 232 754894 30.73 42 50 0.84 64 135 0.47 21 66 0.32 14 14 11
D438 DH477 L 1098 4646732 23.63 231 68 3.40 199 225 0.88 272 100 2.72 12 14 14
D439 DH478 L 314 3458045 9.08 31 58 0.53 50 180 0.28 11 81 0.14 14 13 12
D440 DH479 L 750 2605914 28.78 78 68 1.15 132 225 0.59 198 100 1.98 10 14 12
D441 DH480 S 152 1506843 10.09 16 34 0.47 27 90 0.30 7 42 0.17 13 13 12

Total Total Total
D442 DH481 L 645 2159775 29.86 73 68 1.07 132 225 0.59 100 100 1.00 14 14 12
D443 DH482 L 700 2251744 31.09 77 68 1.13 124 225 0.55 209 100 2.09 14 14 12
D444 DH483 L 543 3998252 13.58 65 68 0.96 128 225 0.57 57 100 0.57 13 14 12
D445 DH484 S 154 1870374 8.23 32 34 0.94 31 90 0.34 22 42 0.52 14 13 12
D446 DH485 S 103 1064493 9.68 13 34 0.38 31 90 0.34 10 42 0.24 13 14 11
D447 DH486 L 422 1879809 22.45 65 68 0.96 93 225 0.41 35 100 0.35 13 14 12
D448 DH487 S 185 3038252 6.09 27 34 0.79 60 90 0.67 88 42 2.10 14 13 11
D449 DH488 L 545 1616450 33.72 32 68 0.47 135 225 0.60 32 100 0.32 14 11 12
D450 DH489 L 468 1726601 27.11 69 68 1.01 120 225 0.53 158 100 1.58 14 14 13
D451 DH490 L 375 735394 50.99 43 58 0.74 114 180 0.63 196 81 2.42 14 13 10
D452 DH491 L 477 565223 84.39 63 68 0.93 109 225 0.48 40 100 0.40 12 13 11
D453 DH492 S 168 1618345 10.38 22 34 0.65 49 90 0.54 87 42 2.07 12 9 8
D454 DH493 L 613 1353445 45.29 63 68 0.93 122 225 0.54 51 100 0.51 14 14 12
D455 DH494 M 300 3482056 8.62 33 50 0.66 60 135 0.44 12 66 0.18 14 14 12
D456 DH495 M 222 1339101 16.58 19 50 0.38 55 135 0.41 77 66 1.17 13 14 12
D457 DH496 L 526 2405890 21.86 24 68 0.35 76 225 0.34 148 100 1.48 13 12 11
D458 DH497 M 296 1245899 23.76 18 50 0.36 66 135 0.49 153 66 2.32 14 9 9
D459 DH498 L 370 3728104 9.92 53 58 0.91 104 180 0.58 15 81 0.19 14 14 12
D460 DH499 L 354 1264277 28.00 23 58 0.40 54 180 0.30 47 81 0.58 14 13 12
D461 DH500 M 210 2722290 7.71 35 50 0.70 60 135 0.44 29 66 0.44 14 13 12

Annexures
D462 DH501 M 256 3077233 8.32 34 50 0.68 68 135 0.50 34 66 0.52 14 12 10
149
150
Total Total Total
Annexures
D463 DH502 L 726 2479052 29.29 70 68 1.03 121 225 0.54 179 100 1.79 11 14 11
D464 DH503 M 226 2464875 9.17 19 50 0.38 47 135 0.35 23 66 0.35 12 12 11

D465 DH504 L 413 1750176 23.60 37 68 0.54 79 225 0.35 126 100 1.26 14 14 12
D466 DH505 M 300 3936331 7.62 23 50 0.46 64 135 0.47 53 66 0.80 12 14 10

D467 DH506 L 304 3458873 8.79 31 58 0.53 37 180 0.21 28 81 0.35 8 12 11
D468 DH507 L 386 1942288 19.87 35 58 0.60 109 180 0.61 154 81 1.90 14 14 12
D469 DH508 S 200 3943323 5.07 26 34 0.76 45 90 0.50 135 42 3.21 11 12 13
D470 DH509 L 500 3776269 13.24 41 68 0.60 107 225 0.48 11 100 0.11 12 14 14
D471 DH510 M 250 2797370 8.94 41 50 0.82 74 135 0.55 91 66 1.38 14 14 14
D472 DH511 L 450 3488809 12.90 26 68 0.38 110 225 0.49 108 100 1.08 14 13 13
D473 DH512 M 250 1235341 20.24 38 50 0.76 58 135 0.43 131 66 1.98 14 14 14
D474 DH513 S 0 927140 0.00 20 29 0.69 37 45 0.82 12 31 0.39 14 14 14
D475 DH514 S 150 378230 39.66 25 34 0.74 46 90 0.51 66 42 1.57 11 10 9
D476 DH515 S 150 441538 33.97 29 34 0.85 77 90 0.86 124 42 2.95 11 12 10
D477 DH516 S 100 327564 30.53 15 29 0.52 46 45 1.02 96 31 3.10 10 8 7
D478 DH517 S 100 693947 14.41 20 29 0.69 46 45 1.02 74 31 2.39 10 10 9
D479 DH518 S 100 876001 11.42 15 29 0.52 38 45 0.84 97 31 3.13 10 8 6
D480 DH519 S 150 298194 50.30 23 34 0.68 45 90 0.50 75 42 1.79 10 12 9
D481 DH520 S 128 1724409 7.42 46 34 1.35 59 90 0.66 121 42 2.88 10 11 9
D481 DH521 S 200 2694388 7.42 29 34 0.85 84 90 0.93 182 42 4.33 11 4 6
D482 DH522 S 100 870589.8 11.49 42 29 1.45 61 45 1.36 55 31 1.77 8 10 9

Total Total Total
D482 DH523 S 90 783530.8 11.49 6 29 0.21 7 45 0.16 7 31 0.23 7 3 5
D482 DH524 M 232 2019768 11.49 20 50 0.40 10 135 0.07 24 66 0.36 9 8 8
D483 DH528 S 100 2397888 4.17 24 29 0.83 76 45 1.69 119 31 3.84 14 11 9
D484 DH529 S 50 459848.3 10.87 9 29 0.31 10 45 0.22 22 31 0.71 7 7 4
D484 DH530 S 100 919696.7 10.87 13 29 0.45 15 45 0.33 41 31 1.32 6 6 4
D485 DH531 S 100 1446368 6.91 14 29 0.48 55 45 1.22 15 31 0.48 9 5 5
D485 DH532 M 219 3167545 6.91 39 50 0.78 69 135 0.51 113 66 1.71 14 12 7
D486 DH533 S 100 1303048 7.67 33 29 1.14 19 45 0.42 105 31 3.39 11 12 8
D487 DH534 S 135 964843.6 13.99 13 34 0.38 21 90 0.23 42 42 1.00 5 4 4
D487 DH535 L 353 2522887 13.99 46 58 0.79 62 180 0.34 147 81 1.81 9 11 12
D488 DH536 S 176 2365976 7.44 23 34 0.68 23 90 0.26 28 42 0.67 13 10 8
D488 DH537 S 65 873798 7.44 3 29 0.10 13 45 0.29 19 31 0.61 11 3 4
D489 DH538 S 30 315980.1 9.49 5 29 0.17 14 45 0.31 5 31 0.16 6 3 1
D489 DH539 S 74 779417.7 9.49 14 29 0.48 3 45 0.07 29 31 0.94 6 10 7
D489 DH540 S 100 1053267 9.49 7 29 0.24 11 45 0.24 9 31 0.29 6 6 7
D490 DH541 S 30 405882 7.39 6 29 0.21 16 45 0.36 42 31 1.35 8 3 2
D490 DH542 S 103 1393528 7.39 18 34 0.53 42 90 0.47 119 42 2.83 12 10 9
D491 DH543 S 75 1137453 6.59 11 29 0.38 6 45 0.13 40 31 1.29 8 5 5
D491 DH544 S 140 2123246 6.59 26 34 0.76 15 90 0.17 65 42 1.55 9 10 10
D492 DH545 L 325 4448359 7.31 35 58 0.60 90 180 0.50 158 81 1.95 13 10 9

Annexures
D492 DH546 S 114 4448359 2.56 15 34 0.44 23 90 0.26 81 42 1.93 13 3 3
151
152
Total Total Total
Annexures
D493 DH547 S 125 480589.7 26.01 8 34 0.24 19 90 0.21 3 42 0.07 8 4 4
D493 DH548 M 216 830459 26.01 33 50 0.66 13 135 0.10 49 66 0.74 9 12 9

D493 DH549 M 300 1153415 26.01 25 50 0.50 66 135 0.49 37 66 0.56 7 10 8
D494 DH550 S 100 2104407 4.75 15 29 0.52 19 45 0.42 72 31 2.32 8 10 8

D494 DH551 S 75 1578306 4.75 8 29 0.28 10 45 0.22 45 31 1.45 8 2 3
D495 DH552 S 79 929296.4 8.50 9 29 0.31 21 45 0.47 33 31 1.06 13 4 4
D495 DH553 M 234 2752600 8.50 34 50 0.68 49 135 0.36 79 66 1.20 14 11 8
D496 DH554 S 60 619322.3 9.69 9 29 0.31 6 45 0.13 10 31 0.32 13 5 5
D496 DH555 S 50 516101.9 9.69 10 29 0.34 8 45 0.18 37 31 1.19 9 5 7
D496 DH556 S 52 536746 9.69 14 29 0.48 6 45 0.13 11 31 0.35 8 6 6
D496 DH557 S 177 1827001 9.69 25 34 0.74 23 90 0.26 96 42 2.29 11 11 8
D497 DH558 S 100 849024.3 11.78 17 29 0.59 11 45 0.24 29 31 0.94 10 12 10
D497 DH559 S 30 254707.3 11.78 10 29 0.34 14 45 0.31 43 31 1.39 7 5 4
D497 DH560 S 100 849024.3 11.78 15 29 0.52 12 45 0.27 69 31 2.23 10 9 8
D498 DH561 S 100 991730 10.08 21 29 0.72 25 45 0.56 20 31 0.65 11 8 6
D499 DH562 S 191 1406842 13.58 8 34 0.24 24 90 0.27 16 42 0.38 9 4 4
D499 DH563 M 230 1694104 13.58 36 50 0.72 50 135 0.37 37 66 0.56 9 11 8
D500 DH564 S 100 1503797 6.65 18 29 0.62 18 45 0.40 103 31 3.32 9 8 10
D500 DH565 S 18 270683.4 6.65 4 29 0.14 6 45 0.13 21 31 0.68 10 3 3
D501 DH566 S 43 249149.6 17.26 6 29 0.21 17 45 0.38 15 31 0.48 9 4 2
D501 DH567 M 230 1332660 17.26 31 50 0.62 74 135 0.55 77 66 1.17 10 9 10

Total Total Total
D502 DH568 S 114 685385.8 16.63 10 34 0.29 17 90 0.19 33 42 0.79 9 4 3
D502 DH569 S 85 511033.2 16.63 22 29 0.76 53 45 1.18 141 31 4.55 9 11 10
D502 DH570 M 212 1274577 16.63 37 50 0.74 67 135 0.50 107 66 1.62 11 9 7
D503 DH571 S 65 415383.9 15.65 11 29 0.38 20 45 0.44 3 31 0.10 10 5 3
D503 DH572 S 200 1278104 15.65 13 34 0.38 20 90 0.22 34 42 0.81 11 11 8
D503 DH573 S 30 191715.7 15.65 5 29 0.17 4 45 0.09 5 31 0.16 8 5 5
D504 DH574 S 72 869526.5 8.28 7 29 0.24 12 45 0.27 37 31 1.19 9 3 5
D504 DH575 S 146 1763207 8.28 27 34 0.79 64 90 0.71 38 42 0.90 9 9 8
D505 DH576 S 45 899336.2 5.00 5 29 0.17 6 45 0.13 13 31 0.42 6 2 5
D505 DH577 S 80 1598820 5.00 7 29 0.24 13 45 0.29 19 31 0.61 9 5 4
D506 DH578 S 137 1648115 8.31 53 34 1.56 85 90 0.94 31 42 0.74 10 11 10
D507 DH579 S 68 953149.3 7.13 14 29 0.48 28 45 0.62 12 31 0.39 7 3 4
D507 DH580 S 100 1401690 7.13 23 29 0.79 26 45 0.58 15 31 0.48 6 11 8
D507 DH581 S 166 2326806 7.13 30 34 0.88 54 90 0.60 29 42 0.69 11 12 8
D508 DH582 S 80 190144 42.07 6 29 0.21 22 45 0.49 51 31 1.65 9 4 5
D508 DH583 S 150 356520 42.07 17 34 0.50 32 90 0.36 68 42 1.62 12 11 10
D509 DH584 S 134 1493978 8.97 7 34 0.21 17 90 0.19 5 42 0.12 5 3 4
D509 DH585 S 174 1939941 8.97 28 34 0.82 19 90 0.21 35 42 0.83 13 10 7
D510 DH586 L 305 3036935 10.04 53 58 0.91 45 180 0.25 63 81 0.78 10 11 10
D510 DH587 S 141 1403960 10.04 20 34 0.59 43 90 0.48 78 42 1.86 8 4 5

Annexures
D511 DH588 S 30 338046.4 8.87 4 29 0.14 5 45 0.11 9 31 0.29 10 4 2
153
154
Total Total Total
Annexures
D511 DH589 S 68 766238.6 8.87 16 29 0.55 20 45 0.44 26 31 0.84 11 9 6
D512 DH590 S 64 1056218 6.06 12 29 0.41 23 45 0.51 79 31 2.55 9 3 4

D512 DH591 S 184 3036627 6.06 25 34 0.74 17 90 0.19 68 42 1.62 10 10 9
D513 DH592 S 70 1095296 6.39 16 29 0.55 12 45 0.27 61 31 1.97 7 7 6

D513 DH593 S 30 469412.4 6.39 13 29 0.45 18 45 0.40 49 31 1.58 9 5 5
D514 DH594 S 60 618283.2 9.70 11 29 0.38 29 45 0.64 6 31 0.19 12 2 3
D514 DH595 S 104 1071691 9.70 26 34 0.76 12 90 0.13 21 42 0.50 9 9 9
D515 DH596 S 100 1834369 5.45 12 29 0.41 30 45 0.67 65 31 2.10 8 4 4
D515 DH597 S 145 2659835 5.45 26 34 0.76 19 90 0.21 90 42 2.14 10 10 7
D516 DH598 S 47 428923.9 10.96 11 29 0.38 21 45 0.47 53 31 1.71 9 3 4
D516 DH599 S 172 1569679 10.96 46 34 1.35 22 90 0.24 81 42 1.93 13 11 10
D517 DH600 S 100 1840221 5.43 20 29 0.69 23 45 0.51 71 31 2.29 8 9 6
D518 DH601 S 100 1656616 6.04 36 29 1.24 55 45 1.22 188 31 6.06 10 11 10
D519 DH602 S 100 1796184 5.57 33 29 1.14 33 45 0.73 153 31 4.94 10 12 8
D520 DH603 L 423 2497263 16.94 69 68 1.01 149 225 0.66 283 100 2.83 12 11 11
D520 DH604 S 68 401451.3 16.94 19 29 0.66 13 45 0.29 65 31 2.10 10 9 7
D520 DH605 S 100 590369.6 16.94 34 29 1.17 32 45 0.71 52 31 1.68 9 11 8
D520 DH606 S 185 1092184 16.94 22 34 0.65 43 90 0.48 179 42 4.26 13 3 7
D521 DH607 S 30 1436719 2.09 7 29 0.24 4 45 0.09 41 31 1.32 9 6 3
D522 DH608 S 100 1599596 6.25 35 29 1.21 27 45 0.60 46 31 1.48 10 11 7
D523 DH609 S 100 3564544 2.81 42 29 1.45 71 45 1.58 126 31 4.06 9 13 9

Total Total Total
D524 DH610 S 60 196936.7 30.47 17 29 0.59 24 45 0.53 8 31 0.26 12 5 4
D524 DH611 S 167 548140.3 30.47 28 34 0.82 51 90 0.57 112 42 2.67 9 11 9
D525 DH612 S 60 366477.6 16.37 9 29 0.31 25 45 0.56 19 31 0.61 9 4 3
D525 DH613 S 140 855114.4 16.37 25 34 0.74 20 90 0.22 52 42 1.24 10 9 6
D526 DH614 L 376 745155 50.46 95 58 1.64 79 180 0.44 340 81 4.20 12 11 13
D526 DH615 L 656 1300058 50.46 85 68 1.25 132 225 0.59 383 100 3.83 9 11 9
D526 DH616 L 326 646065.3 50.46 43 58 0.74 111 180 0.62 26 81 0.32 12 5 6
D526 DH617 L 466 923516.6 50.46 87 68 1.28 125 225 0.56 50 100 0.50 14 14 12
D526 DH618 S 110 217997.5 50.46 38 34 1.12 59 90 0.66 30 42 0.71 12 9 8
D526 DH619 S 100 198179.5 50.46 48 29 1.66 61 45 1.36 78 31 2.52 11 11 8
D526 DH620 S 82 162507.2 50.46 33 29 1.14 36 45 0.80 56 31 1.81 9 4 6
D526 DH621 S 100 198179.5 50.46 22 29 0.76 19 45 0.42 12 31 0.39 7 9 5
D526 DH622 S 100 198179.5 50.46 23 29 0.79 5 45 0.11 7 31 0.23 8 11 7
D527 DH623 S 100 2684703 3.72 28 29 0.97 56 45 1.24 77 31 2.48 14 11 6
D528 DH624 S 30 202144.2 14.84 7 29 0.24 12 45 0.27 38 31 1.23 9 3 4
D528 DH625 S 100 673813.8 14.84 20 29 0.69 26 45 0.58 63 31 2.03 10 10 9
D529 DH626 S 30 431199 6.96 5 29 0.17 11 45 0.24 9 31 0.29 9 4 4
D529 DH627 S 100 1437330 6.96 19 29 0.66 58 45 1.29 52 31 1.68 11 11 7
D530 DH628 S 54 603280.4 8.95 11 29 0.38 19 45 0.42 64 31 2.06 10 4 5
D530 DH629 S 100 1117186 8.95 22 29 0.76 40 45 0.89 89 31 2.87 10 11 10

Annexures
D530 DH630 S 74 826717.6 8.95 19 29 0.66 9 45 0.20 79 31 2.55 11 11 9
155
156
Total Total Total
Annexures
D531 DH631 S 30 661551 4.53 6 29 0.21 13 45 0.29 17 31 0.55 11 4 4
D531 DH632 S 70 1543619 4.53 34 29 1.17 28 45 0.62 37 31 1.19 12 10 10

D532 DH633 S 116 1091442 10.63 18 34 0.53 30 90 0.33 41 42 0.98 9 5 4
D532 DH634 M 250 2352247 10.63 40 50 0.80 55 135 0.41 107 66 1.62 12 11 10

D533 DH635 S 88 904252.5 9.73 11 29 0.38 22 45 0.49 63 31 2.03 8 3 3
D533 DH636 S 155 1592717 9.73 44 34 1.29 53 90 0.59 82 42 1.95 11 12 11
D534 DH637 S 187 3367416 5.55 39 34 1.15 21 90 0.23 150 42 3.57 9 11 10
D534 DH638 S 78 1404590 5.55 6 29 0.21 9 45 0.20 6 31 0.19 8 3 6
D535 DH639 S 127 1742470 7.29 13 34 0.38 43 90 0.48 17 42 0.40 11 4 8
D535 DH640 S 175 2401042 7.29 28 34 0.82 26 90 0.29 51 42 1.21 12 11 10
D536 DH641 S 130 1320155 9.85 16 34 0.47 13 90 0.14 21 42 0.50 13 11 10
D536 DH642 S 70 710852.5 9.85 10 29 0.34 17 45 0.38 48 31 1.55 11 6 3
D537 DH643 S 62 822176.6 7.54 9 29 0.31 9 45 0.20 29 31 0.94 11 4 4
D537 DH644 S 180 2386964 7.54 22 34 0.65 20 90 0.22 22 42 0.52 13 9 6
D538 DH525 S 156 1789759 8.72 40 34 1.18 24 90 0.27 47 42 1.12 14 10 10
D538 DH526 S 164 1881542 8.72 22 34 0.65 18 90 0.20 3 42 0.07 10 4 6
D538 DH527 S 199 2283090 8.72 48 34 1.41 22 90 0.24 17 42 0.40 11 10 9
D539 DH645 S 121 1116728 10.84 14 34 0.41 18 90 0.20 34 42 0.81 11 5 8
D539 DH646 M 248 2288831 10.84 28 50 0.56 27 135 0.20 51 66 0.77 12 9 9
D540 DH647 S 150 1734519 8.65 15 34 0.44 45 90 0.50 15 42 0.36 14 9 11
D540 DH648 S 52 601299.9 8.65 10 29 0.34 12 45 0.27 34 31 1.10 5 5 5

Total Total Total
D541 DH649 S 168 1193345 14.08 19 34 0.56 51 90 0.57 72 42 1.71 10 4 7
D541 DH650 L 320 2273037 14.08 40 58 0.69 55 180 0.31 49 81 0.60 12 11 9
D542 DH651 S 70 2192933 3.19 5 29 0.17 4 45 0.09 19 31 0.61 12 7 5
D543 DH652 S 100 1715183 5.83 35 29 1.21 46 45 1.02 16 31 0.52 14 12 8
D544 DH653 S 100 1052142 9.50 20 29 0.69 9 45 0.20 32 31 1.03 10 9 7
D544 DH654 S 50 526071 9.50 18 29 0.62 7 45 0.16 36 31 1.16 7 11 7
D545 DH655 S 108 1040725 10.38 14 34 0.41 29 90 0.32 80 42 1.90 9 4 4
D545 DH656 M 204 1965813 10.38 28 50 0.56 37 135 0.27 138 66 2.09 10 12 9
D546 DH657 S 100 1117361 8.95 14 29 0.48 12 45 0.27 48 31 1.55 12 9 10
D547 DH658 S 100 2559297 3.91 27 29 0.93 36 45 0.80 69 31 2.23 9 13 8
D548 DH659 S 144 1877020 7.67 14 34 0.41 34 90 0.38 100 42 2.38 8 4 4
D548 DH660 S 200 2606972 7.67 34 34 1.00 32 90 0.36 128 42 3.05 11 10 8
D549 DH661 S 100 1862559 5.37 20 29 0.69 5 45 0.11 26 31 0.84 7 12 7
D550 DH662 S 82 1066314 7.69 11 29 0.38 27 45 0.60 12 31 0.39 7 3 4
D550 DH663 M 210 2730803 7.69 34 50 0.68 73 135 0.54 40 66 0.61 7 12 10
D551 DH664 S 60 1097071 5.47 18 29 0.62 32 45 0.71 88 31 2.84 9 5 7
D551 DH665 S 110 2011296 5.47 31 34 0.91 14 90 0.16 37 42 0.88 9 9 10
D552 DH666 S 180 889558.3 20.23 18 34 0.53 38 90 0.42 50 42 1.19 10 4 3
D552 DH667 S 125 617748.8 20.23 29 34 0.85 28 90 0.31 21 42 0.50 14 9 10
D552 DH668 S 153 756124.6 20.23 25 34 0.74 14 90 0.16 68 42 1.62 13 11 8

Annexures
D552 DH669 M 286 1413409 20.23 43 50 0.86 44 135 0.33 39 66 0.59 11 11 9
157
158
Total Total Total
Annexures
D553 DH670 S 36 235897 15.26 9 29 0.31 18 45 0.40 26 31 0.84 6 3 1
D553 DH671 S 59 386609 15.26 19 29 0.66 17 45 0.38 36 31 1.16 7 8 8

D554 DH672 S 45 58046 77.52 19 29 0.66 15 45 0.33 38 31 1.23 9 11 9
D555 DH673 S 68 391605 17.36 15 29 0.52 28 45 0.62 51 31 1.65 10 8 7

D556 DH674 S 45 259648 17.33 11 29 0.38 24 45 0.53 1 31 0.03 8 8 7
D557 DH675 S 132 553169.3 23.86 18 34 0.53 16 90 0.18 15 42 0.36 8 10 10
D557 DH676 S 32 134101.7 23.86 9 29 0.31 5 45 0.11 6 31 0.19 3 3 4
D558 DH677 S 38 665148.5 5.71 8 29 0.28 15 45 0.33 34 31 1.10 11 3 2
D558 DH678 S 70 1225274 5.71 17 29 0.59 22 45 0.49 23 31 0.74 12 8 8
D559 DH679 S 63 518449.3 12.15 22 29 0.76 16 45 0.36 39 31 1.26 10 11 10
D559 DH680 S 53 436155.7 12.15 7 29 0.24 8 45 0.18 15 31 0.48 10 2 0
D560 DH681 S 44 129703.1 33.92 8 29 0.28 18 45 0.40 18 31 0.58 6 3 0
D560 DH682 S 120 353735.9 33.92 26 34 0.76 29 90 0.32 25 42 0.60 8 11 9
D561 DH683 S 50 242285 20.64 16 29 0.55 13 45 0.29 33 31 1.06 4 8 5
D562 DH684 S 76 618931 12.28 18 29 0.62 28 45 0.62 61 31 1.97 8 11 9
D563 DH685 S 125 1648902 7.58 11 34 0.32 24 90 0.27 17 42 0.40 12 11 9
D564 DH686 S 108 225628.4 47.87 14 34 0.41 13 90 0.14 24 42 0.57 10 6 5
D564 DH687 S 50 104457.6 47.87 14 29 0.48 13 45 0.29 24 31 0.77 11 8 5
D565 DH688 M 282 1501983 18.78 55 50 1.10 84 135 0.62 34 66 0.52 14 13 7
D566 DH689 M 286 3502404 8.17 58 50 1.16 129 135 0.96 186 66 2.82 12 14 10
D567 DH690 L 430 1676276 25.65 49 68 0.72 226 225 1.00 37 100 0.37 14 13 11
Total Total Total
D568 DH691 L 365 952105.1 38.34 61 58 1.05 136 180 0.76 141 81 1.74 13 14 9
D568 DH692 L 343 894717.9 38.34 37 58 0.64 156 180 0.87 93 81 1.15 13 14 10
D569 DH693 L 636 4850029 13.11 71 68 1.04 177 225 0.79 39 100 0.39 12 13 10
D570 DH694 L 625 5519145 11.32 72 68 1.06 168 225 0.75 41 100 0.41 13 14 10
D571 DH695 L 700 3872846 18.07 67 68 0.99 243 225 1.08 193 100 1.93 14 14 10
D572 DH696 L 460 1136548 40.47 73 68 1.07 172 225 0.76 208 100 2.08 13 14 11
D573 DH697 L 500 2819086 17.74 57 68 0.84 156 225 0.69 37 100 0.37 14 13 11
D574 DH698 L 849 5167600 16.43 76 68 1.12 254 225 1.13 33 100 0.33 14 13 8
D575 DH699 L 600 5227040 11.48 66 68 0.97 212 225 0.94 94 100 0.94 11 14 11
D575 DH700 L 549 4782741 11.48 34 68 0.50 132 225 0.59 52 100 0.52 8 13 9
D576 DH701 L 405 1159127 34.94 66 68 0.97 173 225 0.77 26 100 0.26 10 14 10
D577 DH702 L 415 4360388 9.52 62 68 0.91 166 225 0.74 373 100 3.73 14 14 11
D577 DH703 S 70 735487.1 9.52 35 29 1.21 44 45 0.98 65 31 2.10 9 10 4
D578 DH704 L 590 2930115 20.14 89 68 1.31 182 225 0.81 23 100 0.23 14 14 10
D579 DH705 L 625 4849074 12.89 104 68 1.53 339 225 1.51 53 100 0.53 13 14 12
D579 DH706 L 427 3312887 12.89 60 68 0.88 130 225 0.58 23 100 0.23 11 13 7
D580 DH707 L 436 3007134 14.50 51 68 0.75 162 225 0.72 44 100 0.44 14 13 9

Annexures
159
160
ANNEXURE 7 - TABLE 7B - KPIs 6-10
Dist Hospital Raw Raw Den. Den. Raw Raw
DH Code Num. Den. Num. Den. Num. Den. Raw Score Num. Num. Den.
Annexures
Code category Score Score (i) (ii) Score Score
KPI 6 KPI 7 KPI 8 KPI 9 KPI 10
D1 DH1 S 363 126 0.79 0 206 0.00 0 0 0.00 59339 363 8 20.43 76 82 92.68
D2 DH2 S 5621 60 25.67 0 78 0.00 0 0 0.00 66105 362 12 15.22 305 305 100.00

D3 DH3 L 128472 476 73.94 918 2666 34.43 1134 6 189.00 532901 362 54 27.26 6629 4344 —
D4 DH4 L 345131 500 189.11 3498 9087 38.49 5619 30 187.30 592736 0 135 0.00 2982 13007 22.93

D5 DH5 M 108713 300 99.28 3472 12164 28.54 0 0 0.00 106521 313 35 9.72 0 2804 0.00
D5 DH6 L 252314 1098 62.96 0 0 0.00 6231 41 151.98 565377 313 157 11.51 75 6477 1.16
D6 DH7 L 84525 350 66.16 1107 2499 44.30 2050 6 341.67 284121 312 29 31.40 3440 3440 100.00
D7 DH8 M 134755 250 147.68 1658 4139 40.06 1238 4 309.50 318384 311 40 25.59 2522 4513 55.88
D8 DH9 M 93805 257 100.00 1320 2965 44.52 729 6 121.50 381316 313 38 32.06 1452 1452 100.00
D9 DH10 L 127750 350 100.00 4051 5523 73.35 938 6 156.33 250542 0 39 0.00 116 3548 3.27
D10 DH11 M 114340 300 104.42 2319 4565 50.80 588 4 147.00 425208 365 46 25.33 3760 3760 100.00
D11 DH12 L 40653 1077 10.34 2309 3603 64.09 1486 23 64.61 295151 0 103 0.00 2616 2616 100.00
D12 DH13 L 185556 500 101.67 1993 3859 51.65 1888 16 118.00 468617 365 93 13.81 0 3687 0.00
D13 DH14 L 148869 500 81.57 1227 3285 37.35 2370 21 112.86 189074 313 89 6.79 959 3657 26.22
D14 DH15 L 795990 2042 106.80 5168 13569 38.09 21675 66 328.41 1034198 313 320 10.33 7153 12068 59.27
D15 DH16 M 201220 300 183.76 2963 7460 39.72 779 9 86.56 453625 313 59 24.56 79 3033 2.60
D16 DH17 L 148306 350 116.09 2811 5932 47.39 2014 11 183.09 443873 365 43 28.28 641 2896 22.13
D17 DH18 S 17248 150 31.50 215 1256 17.12 311 10 31.10 65716 303 49 4.43 228 788 28.93
D18 DH19 S 1506 68 6.07 57 677 8.42 5 0 0.00 44325 0 21 0.00 144 144 100.00
Note:
Hospital category - S: small (up to 200 beds); M: mid-sized (201-300 beds); L: large (more than 300 beds)
0 - data not provided/ error in submitted data
D19 DH20 S 1451 72 5.52 0 434 0.00 0 0 0.00 39835 292 11 12.40 0 0 —
D20 DH21 M 59790 254 64.49 1148 2932 39.15 2539 19 133.63 181000 301 105 5.73 8 2688 0.30
D21 DH22 S 1052 38 7.58 43 272 15.81 0 2 0.00 30678 303 13 7.79 52 151 34.44
D22 DH23 S 3829 80 13.11 125 849 14.72 78 5 15.60 39282 303 22 5.89 0 188 0.00
D23 DH24 S 4046 70 15.84 46 1001 4.60 0 0 0.00 85638 365 21 11.17 0 0 —
D24 DH25 S 13637 45 83.03 594 3746 15.86 56 3 18.67 113896 299 22 17.31 0 0 —
D25 DH26 S 30502 160 52.23 1181 2282 51.75 320 6 53.33 69854 301 25 9.28 1327 2121 62.56
D26 DH27 S 13822 82 46.18 1068 3119 34.24 32 4 8.00 79894 313 21 12.15 0 0 —
D27 DH28 S 5345 100 14.64 311 1182 26.31 14 1 14.00 19192 301 15 4.25 0 0 —
D28 DH29 S 60100 200 82.33 498 5859 8.50 30 2 15.00 218748 301 29 25.06 2770 3576 77.46
D29 DH30 S 62830 160 107.59 2713 5502 49.31 567 1 567.00 91306 301 27 11.23 935 1749 53.46
D30 DH31 S 65147 200 89.24 1051 6145 17.10 373 4 93.25 160173 310 30 17.22 142 2994 4.74
D31 DH32 S 33085 136 66.65 585 1081 54.12 230 4 57.50 112460 305 20 18.44 573 1049 54.62
D32 DH33 S 53826 200 73.73 1833 5013 36.56 206 4 51.50 147722 301 29 16.92 2697 2734 98.65
D33 DH34 L 365 325 0.31 1442 6073 23.74 234 4 58.50 199736 301 31 21.41 825 7108 11.61
D34 DH35 S 23253 102 62.46 52 3759 1.38 0 2 0.00 78416 313 16 15.66 18 72 25.00
D35 DH36 S 9909 50 54.30 908 1538 59.04 22 2 11.00 63553 305 30 6.95 0 2 0.00
D36 DH37 S 5559 40 38.08 517 1357 38.10 8 1 8.00 66022 301 25 8.77 0 40 0.00
D37 DH38 S 47205 200 64.66 912 2065 44.16 360 6 60.00 48376 301 52 3.09 891 1554 57.34
D38 DH39 S 51962 169 84.24 600 2465 24.34 11 7 1.57 174399 300 32 18.17 774 1516 51.06
D39 DH40 S 43007 200 58.91 1401 4105 34.13 430 3 143.33 79603 300 29 9.15 3009 3020 99.64
D40 DH41 M 92295 220 114.94 3140 5763 54.49 417 3 139.00 204802 301 43 15.82 283 4754 5.95
D41 DH42 S 34132 150 62.34 — — — 787 4 196.75 162212 306 34 15.59 1246 1184 —

Annexures
161
162

Annexures
D42 DH43 L 91444 302 82.96 1658 6947 23.87 506 4 126.50 248716 279 39 22.86 8167 9069 90.05
D43 DH44 M 76313 235 88.97 844 3890 21.70 19 2 9.50 154412 365 39 10.85 2368 3219 73.56
D44 DH45 L 58459 309 51.83 519 2983 17.40 288 5 57.60 144128 305 37 12.77 3334 3883 85.86

D45 DH46 M 52611 262 55.02 651 3449 18.88 136 2 68.00 197922 305 29 22.38 4806 5500 87.38
D46 DH47 S 46174 150 84.34 — — — 990 2 495.00 163443 306 31 17.23 583 3095 18.84
D47 DH48 S 9740 121 22.05 85 1121 7.58 2 3 0.67 55962 297 20 9.42 0 13 0.00

D48 DH49 S 14398 100 39.45 24 17372 0.14 0 2 0.00 193554 305 17 37.33 171 196 87.24
D49 DH50 S 14570 97 41.15 37 3353 1.10 11 0 0.00 154260 303 18 28.28 0 3 —
D50 DH51 S 19196 114 46.13 57 7360 0.77 49 1 49.00 357015 303 17 69.31 1397 663 —
D51 DH52 S 15730 124 34.75 62 5903 1.05 42 3 14.00 159737 303 16 32.95 0 13 —
D52 DH53 S 26494 108 67.21 63 8094 0.78 138 4 34.50 195005 303 22 29.25 1671 2181 76.62
D53 DH54 S 12291 30 112.25 525 5014 10.47 123 2 61.50 138404 303 22 20.76 0 13 —
D54 DH55 S 45468 150 83.05 1283 7189 17.85 179 3 59.67 31162 365 35 2.44 290 429 67.60
D55 DH56 S 5628 100 15.42 81 3666 2.21 0 2 0.00 130209 303 23 18.68 0 0 —
D56 DH57 S 18001 160 30.82 4089 11384 35.92 213 6 35.50 160824 303 33 16.08 0 0 —
D57 DH58 S 12524 60 57.19 514 2969 17.31 914 1 914.00 180083 303 12 49.53 0 0 —
D58 DH59 S 26397 105 68.88 471 7980 5.90 1 4 0.25 159507 299 21 25.40 1439 1555 92.54
D59 DH60 S 0 100 0.00 552 8750 6.31 25 1 25.00 430959 303 12 118.53 429 1416 30.30
D60 DH61 S 18909 100 51.81 152 4465 3.40 87 1 87.00 210613 365 32 18.03 377 349 —
D61 DH62 S 35447 102 95.21 193 6490 2.97 45 3 15.00 230934 303 15 50.81 129 229 56.33
D62 DH63 S 26706 120 60.97 1041 9488 10.97 522 2 261.00 215006 303 19 37.35 2312 2663 86.82
D63 DH64 S 30795 100 84.37 51 9403 0.54 288 3 96.00 290076 303 14 68.38 147 1536 9.57
D64 DH65 S 34950 100 95.75 148 7105 2.08 0 3 0.00 129811 302 14 30.70 955 3683 25.93
D65 DH66 S 11594 75 42.35 13 4000 0.33 20 2 10.00 119934 303 16 24.74 0 0 —
D66 DH67 S 36992 80 126.68 254 6275 4.05 60 2 30.00 261787 303 14 61.71 896 896 100.00
D67 DH68 S 23119 110 57.58 58 6516 0.89 52 3 17.33 0 303 21 0.00 0 790 —
D68 DH69 S 37324 160 63.91 45 5930 0.76 3 3 1.00 262030 303 26 33.26 816 1292 63.16
D69 DH70 S 16976 164 28.36 147 4248 3.46 1305 1 1305.00 239715 365 20 32.84 1003 1285 78.05
D70 DH71 M 91367 300 83.44 1460 7718 18.92 11 1 11.00 279298 305 24 38.16 1365 1724 79.18
D71 DH72 S 76 82 0.25 185 6569 2.82 1067 3 355.67 171853 303 18 31.51 410 491 83.50
D72 DH73 M 84687 300 77.34 679 7759 8.75 63 9 7.00 317677 303 41 25.57 533 4992 10.68
D73 DH74 S 24481 100 67.07 48 3216 1.49 16 5 3.20 231656 303 22 34.75 43 137 31.39
D74 DH75 M 78461 281 76.50 326 7174 4.54 7174 2 3587.00 163844 303 16 33.80 1639 2082 78.72
D75 DH76 S 2296 98 6.42 352 9340 3.77 1702 2 851.00 166666 303 18 30.56 1250 1333 93.77
D76 DH77 S 43777 135 88.84 509 5957 8.54 1380 3 460.00 294508 303 24 40.50 1419 1706 83.18
D77 DH78 S 14801 83 48.86 32 6063 0.53 23 2 11.50 155032 303 23 22.25 0 0 —
D78 DH79 S 0 76 0.00 0 6928 0.00 0 0 0.00 95236 0 15 0.00 0 67 —
D79 DH80 S 20353 73 76.39 68 7638 0.89 0 0 0.00 241423 303 12 66.40 1092 1550 70.45
D80 DH81 S 34834 100 95.44 936 7983 11.72 24 7 3.43 187244 303 19 32.52 5320 5436 97.87
D81 DH82 S 20325 84 66.29 289 8560 3.38 3 1 3.00 199274 303 20 32.88 291 0 —
D82 DH83 S 72772 136 146.60 1738 12362 14.06 1234 3 411.33 418948 305 35 39.25 465 583 79.76
D83 DH84 L 36288 470 21.15 269 14625 1.84 0 0 0.00 182320 303 23 26.16 1781 1941 91.76
D84 DH85 L 197587 598 90.52 2879 8937 32.21 5090 21 242.38 1050839 294 94 38.02 20 3195 0.63
D85 DH86 S 10707 100 29.33 1 328 0.30 24 1 24.00 67664 305 22 10.08 0 0 —
D86 DH87 S 15377 100 42.13 3 1068 0.28 418 2 209.00 80894 264 12 25.53 0 0 —
D87 DH88 S 11556 60 52.77 20 632 3.16 17 1 17.00 54483 276 11 17.95 0 81 0.00

Annexures
163
164

Annexures
D88 DH89 S 43127 178 66.38 1042 3008 34.64 320 2 160.00 195069 365 40 13.36 2407 2588 93.01
D89 DH90 S 69391 175 108.64 131 1331 9.84 243 6 40.50 121210 297 54 7.56 0 1681 0.00
D90 DH91 M 48377 225 58.91 247 1352 18.27 162 2 81.00 117451 288 22 18.54 0 2344 0.00

D91 DH92 L 74848 410 50.02 1191 6054 19.67 339 3 113.00 219743 295 48 15.52 2235 6181 36.16
D92 DH93 S 12133 60 55.40 0 426 0.00 4 0 0.00 54211 303 12 14.91 334 334 100.00
D93 DH94 S 13256 93 39.05 366 1963 18.64 71 6 11.83 76847 365 28 7.52 4179 1347 —

D94 DH95 S 12540 126 27.27 27 1222 2.21 84 1 84.00 130829 0 20 0.00 893 1349 66.20
D95 DH96 S 160 160 0.27 84 1014 8.28 116 2 58.00 116299 0 21 0.00 2875 4765 60.34
D96 DH97 S 36500 100 100.00 30 1413 2.12 16 1 16.00 80948 365 21 10.56 1243 2030 61.23
D97 DH98 S 27766 163 46.67 19 1277 1.49 0 2 0.00 53995 297 20 9.09 0 2886 0.00
D98 DH99 S 40462 114 97.24 476 2168 21.96 69 3 23.00 114729 292 28 14.03 3564 4489 79.39
D99 DH100 S 41622 165 69.11 303 1760 17.22 10 3 3.33 95209 0 22 0.00 1240 1240 100.00
D100 DH101 S 21600 60 98.63 0 1089 0.00 0 1 0.00 52907 300 13 13.57 43 48 89.58
D101 DH102 S 297 100 0.81 79 775 10.19 7 1 7.00 55275 297 17 10.95 76 566 13.43
D102 DH103 S 20663 100 56.61 843 2501 33.71 151 10 15.10 150542 294 48 10.67 0 0 —
D103 DH104 S 15525 100 42.53 12 660 1.82 6 3 2.00 45954 297 19 8.14 328 631 51.98
D104 DH105 L 141638 316 122.80 2119 5330 39.76 3246 11 295.09 1164589 365 68 46.92 3041 11075 27.46
D105 DH106 S 36579 170 58.95 620 2102 29.50 833 5 166.60 261481 294 27 32.94 161 1031 15.62
D106 DH107 S 1698 60 7.75 128 188 68.09 22 1 22.00 102516 297 13 26.55 82 427 19.20
D107 DH108 S 41205 147 76.80 506 2403 21.06 2035 5 407.00 373202 345 111 9.75 526 404 —
D107 DH109 S 19632 97 55.45 460 2176 21.14 0 0 0.00 108297 293 28 13.20 0 0 —
D107 DH110 L 111108 450 67.65 3016 9058 33.30 94 1 94.00 257381 295 254 3.43 282 1682 16.77
D108 DH111 S 117863 188 171.76 1801 7485 24.06 1296 21 61.71 846053 348 163 14.92 1377 3788 36.35
D109 DH112 S 47455 100 130.01 256 3747 6.83 487 15 32.47 868455 345 131 19.22 167 167 100.00
D109 DH113 S 40823 150 74.56 67 945 7.09 1078 5 215.60 468675 313 34 44.04 29 87 33.33
D109 DH114 S 53480 200 73.26 90 1834 4.91 1077 3 359.00 712861 278 88 29.14 225 225 100.00
D110 DH115 M 62673 222 77.35 613 4579 13.39 758 0 0.00 1083995 302 117 30.68 146 414 35.27
D111 DH116 S 23107 200 31.65 0 0 0.00 0 3 0.00 654369 260 36 69.91 0 0 —
D111 DH117 M 157577 300 143.91 2179 10377 21.00 31661 7 4523.00 801401 292 58 47.32 68666 6866 —
D111 DH118 L 77 325 0.06 1687 5885 28.67 1453 3 484.33 678739 295 132 17.43 700 1545 45.31
D112 DH119 S 50207 103 133.55 508 3883 13.08 755 5 151.00 622791 297 31 67.64 650 650 100.00
D113 DH120 S 29209 100 80.02 282 3164 8.91 672 3 224.00 545522 295 91 20.32 295 295 100.00
D114 DH121 S 79964 100 219.08 1158 4841 23.92 859 3 286.33 588391 296 31 64.12 541 666 81.23
D114 DH122 S 56916 180 86.63 506 2156 23.47 827 4 206.75 1006471 294 108 31.70 400 400 100.00
D114 DH123 L 257294 640 110.14 3287 9854 33.36 6050 13 465.38 1333848 294 130 34.90 9317 40405 23.06
D115 DH124 S 85132 200 116.62 1773 5230 33.90 3646 2 1823.00 624308 273 128 17.87 1056 5493 19.22
D115 DH125 L 128596 370 95.22 2199 9237 23.81 1550 3 516.67 568895 273 198 10.52 850 3702 22.96
D116 DH126 M 57960 235 67.57 834 2293 36.37 1211 4 302.75 266627 295 74 12.21 47 457 10.28
D117 DH127 M 276 230 0.33 1055 2790 37.81 1014 8 126.75 303445 300 66 15.33 189 2457 7.69
D118 DH128 M 65297 220 81.32 741 2826 26.22 991 3 330.33 150792 0 11 0.00 0 0 —
D119 DH129 S 24069 119 55.41 140 1427 9.81 — — — 138644 300 13 35.55 0 0 —
D120 DH130 L 0 320 0.00 49 694 7.06 549 14 39.21 160632 365 37 11.89 919 919 100.00
D121 DH131 M 37235 210 48.58 309 1817 17.01 185 3 61.67 111445 306 31 11.75 0 0 —
D122 DH132 S 19629 64 84.03 373 2827 13.19 529 3 176.33 200675 300 5 133.78 130 0 —
D123 DH133 S 26702 100 73.16 9 1110 0.81 61 1 61.00 89396 300 14 21.28 0 107 0.00
D124 DH134 L 32121 363 24.24 775 5148 15.05 3091 10 309.10 204791 298 69 9.96 0 226 —

Annexures
165
166

Annexures
D125 DH135 S 365 150 0.67 121 764 15.84 1004 3 334.67 271707 300 13 69.67 1656 1656 100.00
D126 DH136 S 43860 160 75.10 141 637 22.14 847 3 282.33 162637 310 30 17.49 0 0 —
D127 DH137 M 140 214 0.18 618 1458 42.39 3056 4 764.00 320167 299 32 33.46 4 1103 0.36

D128 DH138 S 11400 50 62.47 9 270 3.33 0 0 0.00 54945 307 5 35.79 0 9 —
D129 DH139 M 44324 206 58.95 126 1716 7.34 233 0 0.00 154964 304 19 26.83 175 2074 8.44
D130 DH140 S 32953 81 111.46 303 1045 29.00 323 2 161.50 76033 310 16 15.33 0 709 —

D131 DH141 M 78913 230 94.00 385 1574 24.46 601 3 200.33 248060 305 29 28.05 0 0 —
D132 DH142 M 301 264 0.31 401 1468 27.32 1487 3 495.67 184987 301 21 29.27 934 1121 83.32
D133 DH143 M 365 241 0.41 625 2831 22.08 103 2 51.50 130822 307 33 12.91 1625 1625 100.00
D134 DH144 S 71161 115 169.53 477 3022 15.78 239 3 79.67 395407 304 24 54.20 0 201 0.00
D135 DH145 S 15489 110 38.58 178 1198 14.86 779 7 111.29 140498 290 17 28.50 108 916 11.79
D136 DH146 M 88632 235 103.33 623 2854 21.83 1003 2 501.50 177249 310 29 19.72 0 165 0.00
D137 DH147 S 41366 200 56.67 102 1100 9.27 1189 3 396.33 97402 300 23 14.12 0 432 0.00
D138 DH148 S 644 200 0.88 563 2490 22.61 1315 6 219.17 266364 365 13 56.14 205 205 100.00
D139 DH149 S 74458 200 102.00 1173 4432 26.47 292 14 20.86 417620 270 72 21.48 325 5093 6.38
D140 DH150 M 169845 300 155.11 294 3603 8.16 4179 6 696.50 704880 284 42 59.09 4 6244 0.06
D141 DH151 S 75011 200 102.75 1580 6419 24.61 1664 2 832.00 553086 284 48 40.57 0 3135 0.00
D142 DH152 S 29572 100 81.02 841 3312 25.39 347 4 86.75 302606 292 22 47.11 0 2930 0.00
D143 DH153 S 57252 176 89.12 395 2377 16.62 744 7 106.29 358717 270 47 28.27 0 8672 0.00
D144 DH154 S 21307 100 58.38 111 2313 4.80 580 10 58.00 310339 280 54 20.53 0 2725 0.00
D145 DH155 S 25830 90 78.63 436 4419 9.87 563 4 140.75 384381 287 35 38.27 0 6483 0.00
D146 DH156 S 62040 175 97.13 1364 4765 28.63 1361 7 194.43 384898 270 36 39.60 0 6434 0.00
D147 DH157 S 86796 92 258.48 1201 4193 28.64 537 2 268.50 353825 292 41 29.55 0 6640 0.00
D148 DH158 S 0 100 0.00 1507 7938 18.98 1502 1 1502.00 0 0 36 0.00 0 3594 0.00
D149 DH159 S 0 48 0.00 36 2361 1.52 206 7 29.43 205734 283 47 15.47 27 304 8.88
D150 DH160 S 29787 100 81.61 64 949 6.74 249 1 249.00 399887 282 44 32.23 0 5300 0.00
D151 DH161 M 47848 300 43.70 914 2334 39.16 2028 13 156.00 248235 288 51 16.90 0 4556 0.00
D152 DH162 S 31565 83 104.19 940 10893 8.63 225 8 28.13 223319 274 47 17.34 0 0 —
D153 DH163 S 32962 109 82.85 452 3462 13.06 1244 6 207.33 332599 282 62 19.02 12 7407 0.16
D154 DH164 S 70737 100 193.80 601 4183 14.37 493 14 35.21 490757 290 55 30.77 0 183 0.00
D155 DH165 S 69216 120 158.03 1391 5368 25.91 2014 2 1007.00 244015 272 47 19.09 503 5160 9.75
D156 DH166 S 54677 200 74.90 633 5587 11.33 256 6 42.67 238313 286 47 17.73 316 3481 9.08
D157 DH167 M 42268 270 42.89 164 1617 10.14 228 7 32.57 236678 293 20 40.39 247 2407 10.26
D158 DH168 M 0 300 0.00 364 2628 13.85 1294 4 323.50 189029 280 8 84.39 810 1226 66.07
D159 DH169 M 3 216 0.00 301 2885 10.43 721 1 721.00 283410 292 25 38.82 36 2678 1.34
D160 DH170 M 27007 215 34.41 123 887 13.87 321 4 80.25 218390 292 26 28.77 21 1040 2.02
D161 DH171 M 119121 300 108.79 416 2590 16.06 995 3 331.67 209144 289 28 25.85 206 1650 12.48
D162 DH172 S 1290 20 17.67 0 9 0.00 0 1 0.00 16108 291 7 7.91 0 0 —
D163 DH173 M 3 300 0.00 1476 5540 26.64 1424 1 1424.00 310246 292 25 42.50 52 3692 1.41
D164 DH174 M 46759 261 49.08 277 1856 14.92 875 8 109.38 274632 289 39 24.37 16 401 3.99
D165 DH175 M 39532 250 43.32 497 1836 27.07 1388 16 86.75 215119 280 67 11.47 77 957 8.05
D166 DH176 S 54954 180 83.64 341 2533 13.46 699 6 116.50 303652 284 22 48.60 77 1365 5.64
D167 DH177 S 3 200 0.00 1273 3665 34.73 158 3 52.67 135824 292 18 25.84 267 2454 10.88
D168 DH178 S 35176 110 87.61 4729 9107 51.93 0 0 0.00 260457 365 20 35.68 511 570 89.65
D168 DH179 S 32115 178 49.43 0 0 0.00 1941 3 647.00 528536 313 67 25.20 770 1368 56.29
D169 DH180 S 7332 64 31.39 644 1188 54.21 996 5 199.20 37550 313 50 2.40 133 191 69.63

Annexures
167
168

Annexures
D170 DH181 S 7300 20 100.00 258 1385 18.63 283 1 283.00 194084 365 23 23.12 0 4 0.00
D171 DH182 S 66425 200 90.99 1982 3871 51.20 1987 15 132.47 575577 312 66 27.95 339 1256 26.99
D172 DH183 S 15998 160 27.39 889 2610 34.06 838 4 209.50 147363 303 23 21.15 436 504 86.51

D173 DH184 S 4252 40 29.12 134 517 25.92 454 2 227.00 313160 313 31 32.27 0 0 —
D174 DH185 S 20587 135 41.78 1628 3322 49.01 1074 6 179.00 423980 309 56 24.50 1144 1536 74.48
D174 DH186 S 0 58 0.00 562 1027 54.72 359 5 71.80 216114 295 38 19.28 0 152 —

D175 DH187 S 7427 160 12.72 1421 3196 44.46 878 3 292.67 235665 308 28 27.33 853 988 86.34
D176 DH188 S 25295 36 192.50 1055 3625 29.10 702 6 117.00 359705 313 36 31.92 24 221 10.86
D177 DH189 S 9980 50 54.68 478 2142 22.32 873 6 145.50 266977 313 38 22.45 205 299 68.56
D178 DH190 S 16885 54 85.67 1059 1582 66.94 1058 12 88.17 682934 0 55 0.00 151 409 36.92
D179 DH191 S 6471 40 44.32 88 1379 6.38 60 4 15.00 93161 302 17 18.15 8 12 66.67
D180 DH192 S 576 50 3.16 25 941 2.66 1919 2 959.50 80778 270 11 27.20 0 0 —
D181 DH193 S 5706 70 22.33 198 1215 16.30 345 5 69.00 210203 305 23 29.96 0 0 —
D182 DH194 S 4082 32 34.95 212 694 30.55 735 2 367.50 246627 313 22 35.82 0 0 —
D183 DH195 S 36530 150 66.72 1985 2184 90.89 1623 5 324.60 560469 313 61 29.35 371 762 48.69
D184 DH196 S 37215 200 50.98 1210 4005 30.21 1644 7 234.86 332695 302 35 31.48 607 1018 59.63
D185 DH197 S 865 100 2.37 138 1227 11.25 0 0 0.00 93599 302 22 14.09 0 0 —
D186 DH198 S 6418 27 65.12 4 2617 0.15 7 1 7.00 57164 302 11 17.21 36 58 62.07
D187 DH199 S 18506 100 50.70 301 4914 6.13 48 2 24.00 142282 307 24 19.31 4869 5298 91.90
D188 DH200 S 15306 103 40.71 81 2976 2.72 14 2 7.00 110291 303 23 15.83 462 736 62.77
D189 DH201 S 13204 100 36.18 383 5703 6.72 383 2 191.50 132630 0 20 0.00 1810 2158 83.87
D190 DH202 S 12512 100 34.28 218 6496 3.36 8 3 2.67 102688 303 17 19.94 626 3333 18.78
D191 DH203 S 19676 100 53.91 235 6323 3.72 0 1 0.00 111040 303 17 21.56 0 0 —
D192 DH204 S 14068 182 21.18 401 3805 10.54 95 2 47.50 91964 303 19 15.97 296 2370 12.49
D193 DH205 L 26087 326 21.92 2367 8655 27.35 0 5 0.00 13964 303 22 2.09 0 0 —
D194 DH206 S 4910 100 13.45 64 3051 2.10 0 3 0.00 48829 0 12 0.00 0 4 0.00
D195 DH207 S 4416 60 20.16 182 1673 10.88 0 1 0.00 73685 0 15 0.00 0 62 —
D196 DH208 S 3312 100 9.07 473 3333 14.19 0 3 0.00 76578 303 12 21.06 1312 1663 78.89
D197 DH209 S 7098 60 32.41 92 1461 6.30 12 1 12.00 90357 302 12 24.93 136 179 75.98
D198 DH210 S 16807 50 92.09 250 2316 10.79 36 1 36.00 86895 302 19 15.14 1241 1484 83.63
D199 DH211 S 6526 100 17.88 42 3554 1.18 42 2 21.00 47125 330 9 15.87 0 0 —
D200 DH212 S 22499 200 30.82 856 6403 13.37 532 5 106.40 231613 0 25 0.00 8803 10066 87.45
D201 DH213 S 31589 100 86.55 112 2007 5.58 10 3 3.33 119530 355 23 14.64 2419 4462 54.21
D202 DH214 S 18389 100 50.38 349 1239 28.17 167 1 167.00 126722 301 20 21.05 0 602 —
D203 DH215 S 13171 40 90.21 285 3130 9.11 0 2 0.00 83081 0 19 0.00 31 31 100.00
D204 DH216 S 25371 200 34.75 2101 6260 33.56 75 2 37.50 359753 301 44 27.16 79 431 18.33
D205 DH217 S 0 60 0.00 997 3183 31.32 2 1 2.00 57862 303 15 12.73 265 876 30.25
D206 DH218 S 16891 80 57.85 131 1255 10.44 0 0 0.00 68993 0 14 0.00 0 0 —
D207 DH219 S 4870 100 13.34 96 1420 6.76 26 2 13.00 58728 303 17 11.40 495 636 77.83
D208 DH220 M 20145 300 18.40 627 3122 20.08 317 5 63.40 161035 365 19 23.22 194 1000 19.40
D209 DH221 S 6485 120 14.81 1199 3455 34.70 0 0 0.00 38198 365 11 9.51 0 256 0.00
D209 DH222 S 1150115 200 0.00 566 764 74.08 790 6 131.67 105594 365 44 6.57 0 345 —
D209 DH223 M 58491 285 56.23 1995 4246 46.99 807 10 80.70 302302 365 53 15.63 0 0 —
D209 DH224 L 195884 536 100.12 10488 307517 3.41 0 0 0.00 139527 365 167 2.29 0 0 —
D209 DH225 L 219985 764 78.89 0 0 0.00 6929 78 88.83 432513 0 285 0.00 1241 10366 11.97
D209 DH226 L 99825 360 75.97 1935 4084 47.38 2224 8 278.00 264771 365 46 15.77 0 3904 0.00

Annexures
169
170

Annexures
D209 DH227 L 139953 1030 37.23 786 2332 33.70 5469 28 195.32 461095 365 114 11.08 0 3432 0.00
D210 DH228 L 266222 740 98.56 2450 8554 28.64 3199 11 290.82 402032 365 131 8.41 0 6811 0.00
D211 DH229 M 26538 210 34.62 2521 5604 44.99 160 4 40.00 294749 365 43 18.78 0 421 0.00

D211 DH230 L 298375 1017 80.38 2957 7290 40.56 8332 15 555.47 337131 365 170 5.43 0 22074 0.00
D212 DH231 L 0 450 0.00 2623 7660 34.24 2695 0 0.00 336430 365 179 5.15 6831 1854 —
D213 DH232 M 250 250 0.27 2476 2476 100.00 3063 17 180.18 320865 365 17 51.71 0 1977 0.00

D214 DH233 M 105850 300 96.67 1375 3597 38.23 1849 15 123.27 327360 365 58 15.46 1588 2541 62.50
D215 DH234 S 45373 140 88.79 2110 3527 59.82 795 6 132.50 454292 250 29 62.66 0 0 —
D216 DH235 L 96622 400 66.18 1652 3248 50.86 2236 1 2236.00 — — — — 66 1895 3.48
D217 DH236 L 145314 450 88.47 4529 7839 57.78 950 6 158.33 333137 365 33 27.66 664 1210 54.88
D218 DH237 M 100775 272 101.51 2829 5946 47.58 0 0 0.00 38612 365 33 3.21 0 14590 0.00
D218 DH238 L 211765 905 64.11 0 0 0.00 4685 55 85.18 293712 365 117 6.88 106 18237 0.58
D219 DH239 S 7016 100 19.22 1947 4979 39.10 0 0 0.00 39198 365 8 13.42 0 382 —
D219 DH240 L 45645 930 13.45 3564 10032 35.53 11040 9 1226.67 512047 365 38 36.92 378 2444 15.47
D220 DH241 M 62894 250 68.92 1086 3447 31.51 1338 4 334.50 291813 365 20 39.97 0 1361 0.00
D220 DH242 L 309513 1200 70.67 3786 10731 35.28 5352 35 152.91 484139 365 284 4.67 161 8472 1.90
D221 DH243 M 101973 250 111.75 2287 4393 52.06 671 2 335.50 188480 365 9 57.38 400 3260 12.27
D222 DH244 L 37863 560 18.52 4642 10709 43.35 1303 20 65.15 397346 365 106 10.27 3679 1779 —
D223 DH245 L 750 750 0.27 3300 8550 38.60 820 26 31.54 556463 365 176 8.66 1310 6472 20.24
D224 DH246 M 29458 300 26.90 1707 4578 37.29 398 2 199.00 237529 365 31 20.99 74 2655 2.79
D225 DH247 L 96211 410 64.29 942 3125 30.14 1465 17 86.18 269350 365 80 9.22 0 1597 0.00
D226 DH248 L 99445 400 68.11 2727 5456 49.98 326 8 40.75 472743 365 43 30.12 0 1867 —
D227 DH249 M 93946 300 85.80 1827 5071 36.03 655 1 655.00 170267 365 8 58.31 0 1905 0.00
D228 DH250 L 198281 650 83.57 2648 6846 38.68 978 25 39.12 751845 365 197 10.46 9527 15642 60.91
D229 DH251 L 128686 410 85.99 3329 11443 29.09 0 1 0.00 163552 365 83 5.40 581 6683 8.69
D229 DH252 L 229601 1020 61.67 0 0 0.00 9207 15 613.80 457213 365 45 27.84 10202 14416 70.77
D230 DH253 L 147693 640 63.22 1554 5639 27.56 1869 12 155.75 340126 365 124 7.51 9507 9507 100.00
D231 DH254 S 7949 100 21.78 632 1098 57.56 411 2 205.50 249122 0 16 0.00 0 1411 0.00
D232 DH255 L 323998 950 93.44 4122 10111 40.77 6316 34 185.76 731871 0 148 0.00 322 12568 2.56
D233 DH256 L 114322 400 78.30 3669 6132 59.83 1967 11 178.82 481730 365 43 30.69 164 3395 4.83
D234 DH257 M 78377 250 85.89 917 1924 47.66 311 3 103.67 171359 365 28 16.77 0 8271 —
D235 DH258 L 40923 316 35.48 449 982 45.72 544 4 136.00 274290 365 9 83.50 0 1021 0.00
D236 DH259 S 100 100 0.27 464 3313 14.01 12 2 6.00 146455 365 19 21.12 1457 1370 —
D237 DH260 M 38557 255 41.43 767 1538 49.87 0 0 0.00 99872 313 24 13.29 274 326 84.05
D237 DH261 L 58495 400 40.07 0 0 0.00 494 7 70.57 621672 313 54 36.78 0 0 —
D238 DH262 M 42024 227 50.72 761 1135 67.05 656 4 164.00 392327 365 32 33.59 6373 6373 100.00
D238 DH263 L 154476 639 66.23 1033 2511 41.14 3331 6 555.17 683100 365 91 20.57 0 168 0.00
D239 DH264 S 36121 144 68.72 478 878 54.44 382 5 76.40 317913 313 32 31.74 0 0 —
D240 DH265 L 152615 541 77.29 1818 3906 46.54 2367 11 215.18 393053 315 56 22.28 0 7463 0.00
D241 DH266 L 70710 364 53.22 511 1594 32.06 681 8 85.13 305597 365 52 16.10 2413 3139 76.87
D242 DH267 M 66312 273 66.55 2975 5788 51.40 0 0 0.00 268579 0 31 0.00 160 160 100.00
D242 DH268 L 145410 537 74.19 0 0 0.00 — — — 781154 0 63 0.00 6599 6599 100.00
D243 DH269 L 13897 360 10.58 645 1213 53.17 422 8 52.75 674648 313 61 35.33 187 666 28.08
D244 DH270 L 96791 525 50.51 222 729 30.45 762 11 69.27 756556 0 60 0.00 36 1097 3.28
D245 DH271 S 43425 164 72.54 304 783 38.83 369 5 73.80 529530 365 34 42.67 0 1356 0.00
D245 DH272 L 189007 501 103.36 1569 5161 30.40 6600 52 126.92 915886 0 48 0.00 0 5885 0.00

Annexures
171
172

Annexures
D246 DH273 M 78800 250 86.36 2091 5695 36.72 0 0 0.00 175030 365 21 22.83 0 0 —
D246 DH274 L 173269 544 87.26 0 0 0.00 1328 2 664.00 459276 303 47 32.25 70 27366 0.26
D247 DH275 L 0 403 0.00 399 808 49.38 589 9 65.44 306254 365 55 15.26 1072 1842 58.20

D248 DH276 M 41156 300 37.59 241 760 31.71 137 7 19.57 535748 0 54 0.00 2 78 2.56
D248 DH277 L 174295 747 63.93 0 0 0.00 5872 7 838.86 747663 0 77 0.00 0 3812 0.00
D248 DH278 L 88529 428 56.67 2210 5719 38.64 0 0 0.00 300097 365 38 21.64 0 399 —

D249 DH279 M 68340 240 78.01 1011 3049 33.16 383 5 76.60 569318 0 48 0.00 2 1110 0.18
D250 DH280 M 119712 296 110.80 521 2284 22.81 685 10 68.50 514537 365 63 22.38 82 3170 2.59
D251 DH281 S 23744 160 40.66 337 1697 19.86 9 9 1.00 96949 303 34 9.41 65 622 10.45
D252 DH282 M 19490 250 21.36 424 1506 28.15 766 9 85.11 158443 303 38 13.76 321 902 35.59
D253 DH283 S 4148 50 22.73 130 294 44.22 24 1 24.00 109214 305 21 17.05 0 0 —
D254 DH284 S 16945 100 46.42 18 3666 0.49 0 2 0.00 189090 285 22 30.16 0 186 0.00
D255 DH285 S 50900 110 126.77 5 2158 0.23 43 3 14.33 118537 285 34 12.23 20 839 2.38
D256 DH286 S 15870 100 43.48 489 2514 19.45 568 2 284.00 128420 285 20 22.53 490 2131 22.99
D257 DH287 S 45823 100 125.54 122 4514 2.70 58 4 14.50 200375 285 27 26.04 0 444 —
D258 DH288 M 59949 300 54.75 2819 7842 35.95 393 5 78.60 173104 285 31 19.59 5364 6444 83.24
D259 DH289 M 204139 300 186.43 700 6337 11.05 849 11 77.18 231702 285 35 23.23 6796 11094 61.26
D260 DH290 M 128654 300 117.49 688 5766 11.93 497 3 165.67 253899 285 28 31.82 4823 6574 73.36
D261 DH291 L 159 350 0.12 250 9431 2.65 1300 8 162.50 4459695 285 50 312.96 2127 1896 —
D262 DH292 L 120450 330 100.00 1391 5176 26.87 3602 15 240.13 622046 285 76 28.72 284 1083 26.22
D263 DH293 S 33788 200 46.28 808 5736 14.09 187 3 62.33 251784 285 23 38.41 1508 4110 36.69
D264 DH294 M 109284 300 99.80 1302 8722 14.93 1773 8 221.63 317164 285 57 19.52 477 5227 9.13
D265 DH295 L 184378 400 126.29 2574 10384 24.79 689 7 98.43 304038 285 53 20.13 1164 11042 10.54
D266 DH296 M 87948 300 80.32 983 6869 14.31 40 6 6.67 37150 285 32 4.07 920 2678 34.35
D267 DH297 L 36868 350 28.86 277 4536 6.11 329 6 54.83 283382 285 44 22.60 1398 1530 91.37
D268 DH298 L 89166 400 61.07 1362 7424 18.35 146 2 73.00 332644 285 43 27.14 1356 2274 59.63
D269 DH299 M 236193 300 215.70 661 5474 12.08 464 3 154.67 242924 285 46 18.53 470 3762 12.49
D270 DH300 S 29765 100 81.55 100 1798 5.56 0 1 0.00 69992 285 21 11.69 101 744 13.58
D271 DH301 L 148410 400 101.65 643 6942 9.26 1005 7 143.57 240827 285 35 24.14 649 6687 9.71
D272 DH302 S 23169 200 31.74 833 6653 12.52 2562 4 640.50 329651 285 45 25.70 1069 1862 57.41
D273 DH303 S 51359 100 140.71 768 4055 18.94 275 5 55.00 146567 289 31 16.36 1564 2629 59.49
D274 DH304 M 97271 300 88.83 2060 5812 35.44 686 6 114.33 213590 285 38 19.72 3352 3461 96.85
D275 DH305 S 27285 100 74.75 339 2818 12.03 37 4 9.25 259014 285 37 24.56 0 170 —
D276 DH306 L 84856 500 46.50 0 0 0.00 2044 11 185.82 211527 285 48 15.46 66 6249 1.06
D277 DH307 S 54082 200 74.08 67 1508 4.44 378 2 189.00 126351 285 27 16.42 319 2542 12.55
D278 DH308 S 83541 200 114.44 586 4707 12.45 163 6 27.17 212244 285 24 31.03 109 6668 1.63
D279 DH309 L 99381 400 68.07 2290 7639 29.98 154 1 154.00 384022 285 28 48.12 5509 6491 84.87
D280 DH310 M 0 300 0.00 1982 8475 23.39 1408 5 281.60 236631 285 41 20.25 990 10786 9.18
D281 DH311 M 147 300 0.13 139 3556 3.91 236 4 59.00 164828 285 25 23.13 3500 3927 89.13
D282 DH312 L 76833 500 42.10 2207 6545 33.72 459 6 76.50 243198 285 34 25.10 0 5400 0.00
D283 DH313 M 214736 300 196.11 415 11269 3.68 346 7 49.43 355643 285 42 29.71 346 3657 9.46
D284 DH314 M 62635 300 57.20 1147 4454 25.75 423 3 141.00 21638 285 22 3.45 479 4383 10.93
D285 DH315 S 38305 200 52.47 302 4952 6.10 296 4 74.00 192440 285 28 24.12 1360 1360 100.00
D286 DH316 S 58286 200 79.84 561 3113 18.02 58 3 19.33 153203 285 21 25.60 779 1598 48.75
D287 DH317 S 46355 200 63.50 861 3727 23.10 1201 4 300.25 229350 285 32 25.15 979 989 98.99
D288 DH318 M 128578 300 117.42 274 4636 5.91 19 2 9.50 177508 285 21 29.66 3316 4048 81.92

Annexures
173
174

Annexures
D289 DH319 L 170333 500 93.33 1170 8199 14.27 899 7 128.43 514658 285 45 40.13 7839 8640 90.73
D290 DH320 S 6995 100 19.16 158 2294 6.89 82 5 16.40 227589 285 35 22.82 0 11 0.00
D291 DH321 M 49375 300 45.09 2036 8457 24.07 112 4 28.00 103368 285 37 9.80 0 8903 0.00

D292 DH322 L 190174 400 130.26 2561 10949 23.39 1740 6 290.00 374867 285 50 26.31 10370 13611 76.19
D293 DH323 M 88637 240 101.18 740 5364 13.80 288 4 72.00 361531 285 29 43.74 3763 4275 88.02
D294 DH324 L 97344 400 66.67 1830 5905 30.99 149 1 149.00 294692 365 27 29.90 3220 4267 75.46

D295 DH325 M 75558 300 69.00 1995 6775 29.45 453 2 226.50 186280 285 38 17.20 6432 7045 91.30
D296 DH326 S 63161 200 86.52 173 4347 3.98 76 4 19.00 195526 285 20 34.30 204 3555 5.74
D297 DH327 S 35 100 0.10 402 3697 10.87 258 2 129.00 230887 285 31 26.13 1860 118 —
D298 DH328 M 124056 300 113.29 1514 8120 18.65 648 7 92.57 375821 285 45 29.30 2365 2430 97.33
D299 DH329 M 0 300 0.00 31 4073 0.76 0 0 0.00 140723 285 26 18.99 1403 1403 100.00
D300 DH330 S 15516 120 35.42 33 2622 1.26 174 3 58.00 82432 285 24 12.05 1349 504 —
D301 DH331 S 98570 200 135.03 345 6260 5.51 497 1 497.00 191668 285 27 24.91 115 2165 5.31
D302 DH332 L 161423 700 63.18 2457 6970 35.25 988 11 89.82 353147 285 54 22.95 1842 6261 29.42
D303 DH333 S 45394 100 124.37 302 2350 12.85 310 3 103.33 103685 285 18 20.21 109 1258 8.66
D304 DH334 M 109500 300 100.00 733 5109 14.35 130 7 18.57 301549 285 39 27.13 4593 4711 97.50
D305 DH335 M 135956 274 135.94 2341 6085 38.47 1410 10 141.00 250899 290 54 16.02 3372 742 —
D306 DH336 L 125607 379 90.80 0 2 0.00 1185 3 395.00 290785 306 50 19.01 775 5974 12.97
D306 DH337 S 109889 189 159.29 3591 10945 32.81 0 1 0.00 48611 297 34 4.81 1 2072 0.05
D307 DH338 L 171625 320 146.94 2646 10394 25.46 1076 10 107.60 417435 305 62 22.07 0 12300 0.00
D308 DH339 L 160937 482 91.48 4023 7530 53.43 899 4 224.75 228078 300 61 12.46 532 6448 8.25
D309 DH340 L 83070 306 74.38 374 3278 11.41 455 4 113.75 191901 298 71 9.07 0 2725 0.00
D310 DH341 M 119294 252 129.70 1822 5359 34.00 1239 9 137.67 156122 294 33 16.09 0 6529 0.00
D311 DH342 S 72912 100 199.76 1009 4814 20.96 94 5 18.80 195141 305 52 12.30 3695 3695 100.00
D312 DH343 L 144217 356 110.99 1932 6984 27.66 3148 15 209.87 284152 283 25 40.16 0 5757 —
D313 DH344 S 34701 60 158.45 501 6001 8.35 0 0 0.00 101684 294 18 19.21 0 0 —
D313 DH345 S 60503 200 82.88 0 0 0.00 395 3 131.67 262620 305 47 18.32 0 667 —
D314 DH346 S 102739 200 140.74 1130 4410 25.62 1028 3 342.67 38000 298 37 3.45 3348 3469 96.51
D315 DH347 L 174819 541 88.53 2525 6899 36.60 2580 9 286.67 326407 296 66 16.71 0 8891 0.00
D316 DH348 M 57108 236 66.30 0 0 0.00 1024 6 170.67 392122 296 42 31.54 0 2736 0.00
D316 DH349 S 51688 60 236.02 1555 6082 25.57 0 0 0.00 31963 300 16 6.66 0 0 —
D317 DH350 L 148190 406 100.00 0 0 0.00 0 4 0.00 354788 300 44 26.88 0 7535 0.00
D317 DH351 S 58122 60 265.40 3735 8702 42.92 0 0 0.00 24184 305 7 11.33 0 0 —
D318 DH352 L 64071 333 52.71 448 1486 30.15 201 9 22.33 352239 294 80 14.98 0 996 0.00
D319 DH353 M 82391 272 82.99 1461 3532 41.36 968 3 322.67 160327 312 47 10.93 0 4955 0.00
D320 DH354 S 76996 200 105.47 921 2863 32.17 561 4 140.25 193781 0 35 0.00 0 6357 0.00
D321 DH355 M 124770 242 141.25 1748 4678 37.37 781 3 260.33 267652 297 41 21.98 0 2351 0.00
D322 DH356 S 34320 200 47.01 93 151 61.59 1655 4 413.75 111075 300 40 9.26 4692 4692 100.00
D323 DH357 M 88451 278 87.17 1045 4031 25.92 525 4 131.25 262251 312 40 21.01 0 1796 0.00
D324 DH358 M 86274 282 83.82 626 2772 22.58 356 4 89.00 497556 0 50 0.00 1 1713 0.06
D325 DH359 S 50816 200 69.61 76 2876 2.64 22 2 11.00 181764 313 28 20.74 1767 1767 100.00
D326 DH360 S 4288 50 23.50 128 731 17.51 14 4 3.50 46775 276 39 4.35 0 90 0.00
D327 DH361 S 803 29 7.59 0 70 0.00 0 1 0.00 14504 268 28 1.93 0 0 —
D328 DH362 S 33385 141 64.87 426 2573 16.56 972 9 108.00 131566 280 72 6.53 1110 1482 74.90
D329 DH363 S 2333 50 12.78 78 654 11.93 0 3 0.00 21426 283 17 4.45 0 0 —
D330 DH364 S 3486 36 26.53 5 245 2.04 22 1 22.00 14490 267 11 4.93 0 11 —

Annexures
175
176

Annexures
D331 DH365 S 4075 64 17.44 422 1623 26.00 24 6 4.00 108220 278 59 6.60 28 75 37.33
D332 DH366 S 2759 50 15.12 0 336 0.00 20 3 6.67 28767 276 21 4.96 0 0 —
D333 DH367 S 43 100 0.12 4 782 0.51 0 0 0.00 39742 0 13 0.00 0 0 —

D334 DH368 L 146596 386 104.05 1690 10272 16.45 230 3 76.67 121084 313 53 7.30 0 0 —
D334 DH369 L 2629 600 1.20 0 0 0.00 942 3 314.00 177502 308 62 9.30 0 0 —
D335 DH370 S 17177 74 63.59 0 578 0.00 0 5 0.00 40974 282 17 8.55 0 0 —

D336 DH371 S 26606 50 145.79 221 1558 14.18 0 0 0.00 28362 0 19 0.00 0 0 —
D336 DH372 S 49966 200 68.45 0 0 0.00 950 5 190.00 55320 307 50 3.60 2294 2819 81.38
D337 DH373 S 38323 108 97.22 119 2726 4.37 42 1 42.00 51632 307 23 7.31 532 70 —
D338 DH374 S 30978 100 84.87 58 1726 3.36 50 5 10.00 48162 306 20 7.87 0 0 —
D338 DH375 S 18262 100 50.03 85 1159 7.33 29 4 7.25 44961 304 12 12.32 0 0 —
D339 DH376 M 79709 280 77.99 1093 4264 25.63 3847 17 226.29 389784 290 83 16.19 4532 24373 18.59
D340 DH377 S 9901 73 37.16 78 714 10.92 139 3 46.33 31692 288 14 7.86 213 1248 17.07
D341 DH378 S 16291 60 74.39 62 677 9.16 242 2 121.00 43387 283 10 15.33 128 745 17.18
D342 DH379 S 8935 34 72.00 32 442 7.24 5 2 2.50 33214 277 12 9.99 369 1037 35.58
D343 DH380 S 36257 143 69.46 207 264 78.41 406 6 67.67 92013 277 31 10.72 530 1778 29.81
D344 DH381 S 4442 26 46.81 16 255 6.27 0 2 0.00 556 284 10 0.20 12 165 7.27
D345 DH382 S 13052 45 79.46 106 648 16.36 86 2 43.00 20928 277 11 6.87 288 792 36.36
D346 DH383 S 18266 51 98.13 13 370 3.51 224 3 74.67 30794 265 14 8.30 175 1067 16.40
D347 DH384 S 14488 150 26.46 827 3680 22.47 580 7 82.86 144945 0 36 0.00 8037 2048 —
D348 DH385 S 23487 150 42.90 179 663 27.00 231 5 46.20 44830 269 18 9.26 168 841 19.98
D349 DH386 S 1789 50 9.80 41 294 13.95 47 4 11.75 17458 280 14 4.45 0 61 0.00
D350 DH387 S 365 163 0.61 1202 6048 19.87 34 3 11.33 224152 365 31 19.81 6968 7171 97.17
D351 DH388 M 86140 236 100.00 2821 9467 29.80 34 9 3.78 285313 365 113 6.92 1696 7408 22.89
D352 DH389 L 147358 360 112.14 5012 12101 41.42 776 20 38.80 364475 365 73 13.68 854 17430 4.90
D353 DH390 S 20682 160 35.41 1294 4318 29.97 156 2 78.00 319057 365 22 39.73 2958 14079 21.01
D354 DH391 S 13434 93 39.58 545 2913 18.71 158 4 39.50 133655 365 28 13.08 547 2536 21.57
D355 DH392 M 108352 269 110.35 1486 6487 22.91 391 6 65.17 321839 365 38 23.20 1042 10960 9.51
D356 DH393 S 19764 130 41.65 604 2232 27.06 1156 3 385.33 385875 365 33 32.04 0 0 —
D357 DH394 S 46720 128 100.00 150 1507 9.95 31 2 15.50 107452 365 16 18.40 107 2431 4.40
D358 DH395 M 80566 288 76.64 2013 5911 34.06 614 3 204.67 343295 365 29 32.43 447 6004 7.45
D359 DH396 S 40515 111 100.00 1445 2920 49.49 82 4 20.50 166102 365 25 18.20 1527 3807 40.11
D360 DH397 S 11700 137 23.40 633 3636 17.41 259 7 37.00 354693 365 33 29.45 0 3 —
D361 DH398 S 45800 126 99.59 1208 4447 27.16 1332 3 444.00 201204 0 25 0.00 1999 2042 97.89
D362 DH399 L 51110 305 45.91 572 8045 7.11 273 4 68.25 320541 365 30 29.27 1226 4620 26.54
D363 DH400 S 44414 116 104.90 319 2833 11.26 49 49 1.00 219040 0 25 0.00 1495 7308 20.46
D364 DH401 S 93203 165 154.76 1335 6960 19.18 83 6 13.83 195800 365 33 16.26 7204 9956 72.36
D365 DH402 S 56890 186 83.80 646 2967 21.77 173 6 28.83 179387 365 39 12.60 2761 5128 53.84
D366 DH403 S 42408 195 59.58 567 6539 8.67 275 3 91.67 274472 365 25 30.08 825 3672 22.47
D367 DH404 S 91126 162 154.11 1936 5720 33.85 162 4 40.50 224787 365 40 15.40 3544 7142 49.62
D368 DH405 L 196993 675 79.96 4691 10872 43.15 6951 11 631.91 786996 365 129 16.71 5491 23034 23.84
D368 DH406 S 66 146 0.12 1205 4862 24.78 959 5 191.80 420643 365 43 26.80 307 2903 10.58
D369 DH407 S 30404 195 42.72 1340 4299 31.17 680 3 226.67 186479 365 34 15.03 722 6234 11.58
D370 DH408 S 66040 125 144.75 678 3480 19.48 104 5 20.80 98505 365 32 8.43 1972 2870 68.71
D371 DH409 M 223497 255 240.13 3001 11021 27.23 3844 24 160.17 333746 365 107 8.55 138 7468 1.85
D372 DH410 S 66739 135 135.44 541 3186 16.98 24 6 4.00 84965 365 24 9.70 6321 7238 87.33

Annexures
177
178

Annexures
D373 DH411 S 65574 168 106.94 271 4107 6.60 350 3 116.67 361145 365 20 49.47 625 4932 12.67
D374 DH412 S 39643 120 90.51 1112 5266 21.12 32 5 6.40 86878 365 16 14.88 3326 3779 88.01
D375 DH413 L 117423 380 84.66 2101 5399 38.91 191 10 19.10 344011 365 50 18.85 1183 5131 23.06

D376 DH414 S 61754 99 170.90 769 4017 19.14 47 6 7.83 151858 365 24 17.34 1793 3601 49.79
D377 DH415 M 0 225 0.00 0 0 0.00 0 0 0.00 0 365 33 0.00 0 0 —
D378 DH416 S 29433 110 73.31 342 2916 11.73 22 3 7.33 198855 365 19 28.67 391 3891 10.05

D379 DH417 L 22768 313 19.93 1979 7661 25.83 953 6 158.83 229487 365 44 14.29 8902 13295 66.96
D379 DH418 S 31984 197 44.48 1278 4713 27.12 12 3 4.00 219304 308 28 25.43 3252 4493 72.38
D380 DH419 L 1107 506 0.60 1433 2387 60.03 3256 2 1628.00 535784 365 58 25.31 451 1935 23.31
D381 DH420 S 24031 171 38.50 180 338 53.25 228 2 114.00 287927 365 19 41.52 76 238 31.93
D382 DH421 L 144258 450 87.83 4312 9927 43.44 0 0 0.00 276970 313 88 10.06 143 1935 7.39
D383 DH422 S 17992 100 49.29 51 298 17.11 366 2 183.00 338164 365 29 31.95 0 0 —
D384 DH423 S 47990 200 65.74 1183 2901 40.78 818 6 136.33 293228 275 37 28.82 0 5748 0.00
D385 DH424 S 27104 160 46.41 1598 5302 30.14 973 4 243.25 286655 262 28 39.08 23 5832 0.39
D386 DH425 S 75645 200 103.62 2139 4961 43.12 1923 7 274.71 368815 276 49 27.27 1208 7953 15.19
D387 DH426 S 38260 100 104.82 607 1691 35.90 670 4 167.50 137678 275 31 16.15 0 443 0.00
D388 DH427 S 23323 80 79.87 267 967 27.61 288 4 72.00 236812 365 32 20.28 0 1365 0.00
D389 DH428 S 16641 75 60.79 527 2514 20.96 202 3 67.33 122286 279 14 31.31 0 3919 0.00
D390 DH429 S 47948 120 109.47 914 2334 39.16 167 2 83.50 227557 276 27 30.54 0 4566 0.00
D391 DH430 S 77370 104 203.82 1306 3130 41.73 1470 5 294.00 186044 294 28 22.60 0 5427 0.00
D392 DH431 S 56718 200 77.70 677 2787 24.29 1323 2 661.50 290966 283 32 32.13 0 4887 0.00
D393 DH432 L 167650 470 97.73 2617 7074 36.99 2279 9 253.22 406878 286 76 18.72 382 9886 3.86
D394 DH433 S 50773 120 115.92 586 1932 30.33 1179 4 294.75 254491 292 30 29.05 0 2810 0.00
D395 DH434 M 95941 270 97.35 2758 8063 34.21 956 8 119.50 254208 286 46 19.32 318 8688 3.66
D396 DH435 S 11676 100 31.99 1135 2974 38.16 758 4 189.50 197398 282 26 26.92 0 5215 0.00
D397 DH436 S 74137 120 169.26 2074 5152 40.26 797 8 99.63 207424 277 25 29.95 0 11224 0.00
D398 DH437 S 41790 200 57.25 678 2324 29.17 1092 7 156.00 324213 290 37 30.22 0 988 0.00
D399 DH438 S 18451 100 50.55 393 2162 18.18 220 2 110.00 147481 275 16 33.52 362 7040 5.14
D400 DH439 S 24140 100 66.14 500 1479 33.81 798 4 199.50 176042 291 22 27.50 0 71 —
D401 DH440 S 36852 150 67.31 1840 4330 42.49 1181 6 196.83 226775 292 34 22.84 3178 14921 21.30
D402 DH441 S 65666 200 89.95 1446 3714 38.93 3918 7 559.71 374200 281 42 31.71 0 233 —
D403 DH442 S 23323 100 63.90 296 1488 19.89 442 5 88.40 249808 287 31 28.08 0 4144 0.00
D404 DH443 S 48886 100 133.93 2637 5106 51.65 673 1 673.00 267851 287 29 32.18 0 6459 0.00
D405 DH444 S 32799 100 89.86 755 1869 40.40 457 5 91.40 279836 282 25 39.69 2984 4767 62.60
D406 DH445 L 146000 400 100.00 1068 8542 12.50 1046 7 149.43 493680 365 33 40.99 187 6629 2.82
D407 DH446 L 205585 701 80.35 2419 12311 19.65 1752 19 92.21 804745 365 79 27.91 7430 7430 100.00
D408 DH447 L 52374 454 31.61 2180 7068 30.84 4186 6 697.67 351520 365 57 16.90 1514 3055 49.56
D409 DH448 L 124182 333 102.17 1195 7072 16.90 674 8 84.25 439988 0 53 0.00 1198 12608 9.50
D410 DH449 M 77998 285 74.98 624 9525 6.55 1843 2 921.50 474102 0 43 0.00 1334 4623 28.86
D411 DH450 L 63139 525 32.95 1097 10402 10.55 834 2 417.00 468812 365 60 21.41 7431 11388 65.25
D412 DH451 L 164060 525 85.62 2381 15126 15.74 2310 9 256.67 491397 365 54 24.93 308 7330 4.20
D413 DH452 M 91010 300 83.11 567 6952 8.16 739 6 123.17 500909 0 58 0.00 4736 4914 96.38
D414 DH453 L 115569 551 57.46 2022 10396 19.45 1248 3 416.00 508249 365 48 29.01 1056 12658 8.34
D415 DH454 M 82475 300 75.32 563 5445 10.34 1283 6 213.83 509663 350 55 26.48 1594 9436 16.89
D416 DH455 M 0 250 0.00 760 10811 7.03 1218 10 121.80 533282 365 50 29.22 1471 3199 45.98
D417 DH456 L 56912 400 38.98 1062 13402 7.92 956 13 73.54 509447 365 44 31.72 2313 5194 44.53

Annexures
179
180

Annexures
D418 DH457 M 38822 256 41.55 442 5485 8.06 587 2 293.50 212668 365 30 19.42 61 1898 3.21
D419 DH458 L 131485 370 97.36 886 4968 17.83 1792 9 199.11 548789 365 68 22.11 405 7771 5.21
D420 DH459 L 37592 307 33.55 1430 6390 22.38 583 9 64.78 43063 365 45 2.62 6593 9297 70.92

D421 DH460 S 3739 150 6.83 118 3378 3.49 256 2 128.00 264491 365 32 22.64 625 1870 33.42
D422 DH461 S 12167 150 22.22 82 2450 3.35 1911 3 637.00 216637 365 57 10.41 301 2721 11.06
D423 DH462 S 87099 200 119.31 108 3643 2.96 2204 16 137.75 559785 362 60 25.77 3813 6375 59.81

D424 DH463 M 365 300 0.33 210 7646 2.75 640 8 80.00 470538 365 39 33.06 3903 4306 90.64
D425 DH464 M 79384 296 73.48 1131 6884 16.43 1374 0 0.00 319800 365 30 29.21 2486 3310 75.11
D426 DH465 L 91027 307 81.23 1018 7543 13.50 2408 3 802.67 456109 0 38 0.00 1488 5863 25.38
D427 DH466 S 27484 150 50.20 48 6040 0.79 959 2 479.50 204839 0 28 0.00 398 2755 14.45
D428 DH467 M 65822 220 81.97 290 4994 5.81 1332 24 55.50 353894 365 27 35.91 1155 4187 27.59
D429 DH468 M 365 294 0.34 1115 8178 13.63 501 15 33.40 385307 365 64 16.49 1970 4725 41.69
D430 DH469 L 146000 400 100.00 1875 7081 26.48 2024 15 134.93 506782 365 72 19.28 2655 8409 31.57
D431 DH470 S 39743 200 54.44 429 3555 12.07 1140 4 285.00 287315 0 28 0.00 746 2213 33.71
D432 DH471 S 119036 200 163.06 1239 8555 14.48 3464 12 288.67 527432 365 44 32.84 587 4077 14.40
D433 DH472 S 19381 105 50.57 89 525 16.95 0 7 0.00 106635 365 31 9.42 0 227 0.00
D434 DH473 S 9665 50 52.96 0 105 0.00 0 0 0.00 17617 274 17 3.78 0 0 —
D435 DH474 S 40437 100 110.79 265 883 30.01 59 7 8.43 130306 274 34 13.99 52 1067 4.87
D436 DH475 S 13097 80 44.85 9 326 2.76 0 0 0.00 56454 275 16 12.83 0 0 —
D437 DH476 M 62160 232 73.41 1146 1986 57.70 1034 9 114.89 503366 365 42 32.84 2 1715 0.12
D438 DH477 L 338008 1098 84.34 3052 5861 52.07 — — — 1110122 365 231 13.17 15373 16002 96.07
D439 DH478 L 100080 314 87.32 1666 2509 66.40 855 10 85.50 693322 365 31 61.27 0 3309 —
D440 DH479 L 217048 750 79.29 3804 5657 67.24 761 19 40.05 1019267 365 78 35.80 0 4459 0.00
D441 DH480 S 42088 152 75.86 380 890 42.70 306 4 76.50 435354 365 16 74.55 0 190 0.00
D442 DH481 L 199382 645 84.69 2447 5990 40.85 1708 22 77.64 1151416 365 73 43.21 0 4391 —
D443 DH482 L 64955 700 25.42 1764 3210 54.95 955 12 79.58 984783 365 77 35.04 0 5889 0.00
D444 DH483 L 168079 543 84.80 2321 4039 57.46 883 13 67.92 969857 365 65 40.88 0 1750 0.00
D445 DH484 S 50850 154 90.46 1001 1292 77.48 565 2 282.50 404529 365 32 34.63 0 1033 0.00
D446 DH485 S 32352 103 86.05 404 558 72.40 60 4 15.00 217674 0 13 0.00 0 496 —
D447 DH486 L 181493 422 117.83 3042 5261 57.82 792 19 41.68 770441 365 65 32.47 0 3971 0.00
D448 DH487 S 55483 185 82.17 1398 2862 48.85 386 3 128.67 458109 365 27 46.48 0 1624 0.00
D449 DH488 L 112210 545 56.41 1220 1774 68.77 543 7 77.57 725117 365 32 62.08 0 1513 0.00
D450 DH489 L 117579 468 68.83 1146 1944 58.95 922 8 115.25 696372 365 69 27.65 0 4212 0.00
D451 DH490 L 62655 375 45.78 1090 1912 57.01 2329 5 465.80 243393 365 43 15.51 0 1247 0.00
D452 DH491 L 161906 477 92.99 2439 4825 50.55 5859 11 532.64 531554 0 63 0.00 0 2808 0.00
D453 DH492 S 52300 168 85.29 1242 2128 58.36 2011 2 1005.50 337424 365 22 42.02 0 1047 0.00
D454 DH493 L 198232 613 88.60 2657 4133 64.29 1603 12 133.58 672462 365 63 29.24 0 3590 0.00
D455 DH494 M 77414 300 70.70 955 1759 54.29 481 2 240.50 476128 365 33 39.53 0 1651 0.00
D456 DH495 M 62337 222 76.93 1472 2943 50.02 362 4 90.50 302276 365 19 43.59 0 2209 —
D457 DH496 L 148070 526 77.12 1779 4217 42.19 729 5 145.80 567703 365 24 64.81 0 3068 —
D458 DH497 M 58716 296 54.35 722 1365 52.89 1326 3 442.00 679311 365 18 103.40 0 1541 0.00
D459 DH498 L 143140 370 105.99 2179 4704 46.32 2065 2 1032.50 917421 365 53 47.42 0 4360 0.00
D460 DH499 L 129210 354 100.00 1063 1566 67.88 190 6 31.67 421782 365 23 50.24 0 216 —
D461 DH500 M 51325 210 66.96 1100 2623 41.94 160 1 160.00 381669 0 35 0.00 0 781 0.00
D462 DH501 M 256 256 0.27 1510 3893 38.79 6991 5 1398.20 529197 365 34 42.64 0 1703 0.00
D463 DH502 L 194982 726 73.58 2685 5519 48.65 1850 9 205.56 917021 365 70 35.89 0 3327 —

Annexures
181
182

Annexures
D464 DH503 M 56516 226 68.51 594 974 60.99 68 1 68.00 432989 365 19 62.44 0 124 —
D465 DH504 L 116519 413 77.30 1872 2890 64.78 720 8 90.00 427940 365 37 31.69 0 2728 0.00
D466 DH505 M 57100 300 52.15 456 905 50.39 513 6 85.50 1092100 365 23 130.09 76 949 8.01

D467 DH506 L 112376 304 101.28 1336 3910 34.17 346 13 26.62 518746 365 31 45.85 0 1630 0.00
D468 DH507 L 113743 386 80.73 2275 3955 57.52 715 6 119.17 500521 365 35 39.18 0 4483 0.00
D469 DH508 S 78117 200 107.01 1971 3295 59.82 871 6 145.17 259090 365 26 27.30 0 0 —

D470 DH509 L 162202 500 88.88 4527 6473 69.94 4913 4 1228.25 324617 0 41 0.00 82 4745 1.73
D471 DH510 M 128450 250 140.77 4272 6530 65.42 461 7 65.86 648194 312 41 50.67 426 3054 13.95
D472 DH511 L 140510 450 85.55 4140 6025 68.71 3240 7 462.86 257916 0 26 0.00 20 1761 1.14
D473 DH512 M 122033 250 133.73 2383 7352 32.41 2282 4 570.50 361168 308 38 30.86 3369 3369 100.00
D474 DH513 S 1189 0 0.00 1151 4644 24.78 943 2 471.50 320626 310 20 51.71 100 673 14.86
D475 DH514 S 27367 150 49.99 25 1031 2.42 0 3 0.00 43345 269 25 6.45 106 319 33.23
D476 DH515 S 61211 150 111.80 836 3427 24.39 105 6 17.50 83390 0 29 0.00 180 3200 5.63
D477 DH516 S 25178 100 68.98 315 1524 20.67 0 2 0.00 47463 253 15 12.51 144 915 15.74
D478 DH517 S 18590 100 50.93 187 1673 11.18 0 1 0.00 63725 267 20 11.93 489 2390 20.46
D479 DH518 S 16126 100 44.18 67 700 9.57 0 0 0.00 47025 265 15 11.83 84 416 20.19
D480 DH519 S 19123 150 34.93 318 1655 19.21 96 4 24.00 37138 275 23 5.87 0 1415 —
D481 DH520 S 26040 128 55.74 0 0 0.00 5276 8 659.50 636399 310 46 44.63 0 1166 0.00
D481 DH521 S 24380 200 33.40 1245 6937 17.95 0 0 0.00 160140 309 29 17.87 0 0 —
D482 DH522 S 37253 100 102.06 57 1907 2.99 2282 6 380.33 536714 0 42 0.00 0 0 —
D482 DH523 S 0 90 0.00 368 10167 3.62 0 0 0.00 151832 365 6 69.33 0 0 —
D482 DH524 M 240000 232 283.42 0 0 0.00 1330 6 221.67 644502 310 20 103.95 219 5094 4.30
D483 DH528 S 60635 100 166.12 820 2853 28.74 1416 5 283.20 308654 286 24 44.97 1481 1656 89.43
D484 DH529 S 4861 50 26.64 0 0 0.00 0 1 0.00 170614 310 9 61.15 0 0 —
D484 DH530 S 6603 100 18.09 0 386 0.00 0 0 0.00 66724 310 13 16.56 0 0 —
D485 DH531 S 36500 100 100.00 1941 7638 25.41 0 0 0.00 157496 270 14 41.67 0 0 —
D485 DH532 M 2558 219 3.20 0 0 0.00 4252 8 531.50 571443 365 39 40.14 12440 12440 100.00
D486 DH533 S 3870 100 10.60 209 1820 11.48 200 3 66.67 272803 282 33 29.31 502 1006 49.90
D487 DH534 S 30801 135 62.51 2032 10861 18.71 0 0 0.00 155829 0 13 0.00 0 0 —
D487 DH535 L 125301 353 97.25 0 0 0.00 0 8 0.00 626695 310 46 43.95 6358 6358 100.00
D488 DH536 S 41616 176 64.78 0 0 0.00 1327 6 221.17 672215 313 23 93.38 2477 2819 87.87
D488 DH537 S 13937 65 58.74 341 7209 4.73 98 0 0.00 108778 310 3 116.97 0 0 —
D489 DH538 S 10800 30 98.63 56 2549 2.20 0 0 0.00 48550 308 5 31.53 206 206 100.00
D489 DH539 S 200 74 0.74 0 0 0.00 20 9 2.22 184800 308 14 42.86 0 0 —
D489 DH540 S 0 100 0.00 50 201 24.88 660 1 660.00 25506 0 7 0.00 1800 2190 82.19
D490 DH541 S 0 30 0.00 19 5864 0.32 0 0 0.00 68562 313 6 36.51 0 0 —
D490 DH542 S 0 103 0.00 0 0 0.00 175 6 29.17 354303 313 18 62.89 134 1517 8.83
D491 DH543 S 29780 75 108.79 2784 6541 42.56 3612 0 0.00 142990 305 11 42.62 0 0 —
D491 DH544 S 1695 140 3.32 0 0 0.00 2044 4 511.00 584986 304 26 74.01 1286 2679 48.00
D492 DH545 L 28890 325 24.35 0 0 0.00 5880 7 840.00 677555 310 35 62.45 1657 1381 —
D492 DH546 S 35864 114 86.19 1406 6327 22.22 0 0 0.00 109656 0 15 0.00 0 0 —
D493 DH547 S 7814 125 17.13 1166 7202 16.19 0 0 0.00 139700 310 8 56.33 0 0 —
D493 DH548 M 15279 216 19.38 0 0 0.00 0 5 0.00 0 0 33 0.00 1040 1040 100.00
D493 DH549 M 310 300 0.28 0 0 0.00 1225 7 175.00 0 310 25 0.00 627 808 77.60
D494 DH550 S 28837 100 79.01 0 0 0.00 673 0 0.00 398929 290 15 91.71 3904 3904 100.00
D494 DH551 S 981 75 3.58 1121 4028 27.83 0 0 0.00 78407 280 8 35.00 0 0 —

Annexures
183
184

Annexures
D495 DH552 S 14520 79 50.36 297 4820 6.16 0 0 0.00 93414 309 9 33.59 0 0 —
D495 DH553 M 20729 234 24.27 0 0 0.00 550 9 61.11 319494 300 34 31.32 2368 171 —
D496 DH554 S 23529 60 107.44 413 8074 5.12 0 0 0.00 129158 310 9 46.29 0 0 —

D496 DH555 S 6983 50 38.26 2 2155 0.09 0 0 0.00 188188 310 10 60.71 0 0 —
D496 DH556 S 5479 52 28.87 0 0 0.00 250 4 62.50 137288 309 14 31.74 0 0 —
D496 DH557 S 16674 177 25.81 0 0 0.00 489 5 97.80 493420 307 25 64.29 250 2641 9.47

D497 DH558 S 2953 100 8.09 39 521 7.49 501 7 71.57 278888 310 17 52.92 1170 1645 71.12
D497 DH559 S 724 30 6.61 91 1147 7.93 0 0 0.00 49167 310 10 15.86 0 0 —
D497 DH560 S 990 100 2.71 50 1067 4.69 501 5 100.20 99683 310 15 21.44 0 0 —
D498 DH561 S 32460 100 88.93 9 3806 0.24 158 4 39.50 283768 265 21 50.99 188 225 83.56
D499 DH562 S 10594 191 15.20 1090 6511 16.74 0 0 0.00 86193 309 8 34.87 0 0 —
D499 DH563 M 66189 230 78.84 0 0 0.00 3124 4 781.00 387865 317 36 33.99 666 5867 11.35
D500 DH564 S 30212 100 82.77 0 0 0.00 0 0 0.00 412620 305 18 75.16 682 967 70.53
D500 DH565 S 360 18 5.48 64 3449 1.86 0 0 0.00 53058 308 4 43.07 0 0 —
D501 DH566 S 7925 43 50.49 386 5439 7.10 0 0 0.00 92241 310 6 49.59 0 0 —
D501 DH567 M 58869 230 70.12 0 0 0.00 1048 7 149.71 688337 310 31 71.63 1985 2301 86.27
D502 DH568 S 48017 114 115.40 920 5466 16.83 0 1 0.00 96009 312 10 30.77 390 390 100.00
D502 DH569 S 8996 85 29.00 0 0 0.00 661 5 132.20 344306 310 22 50.48 0 0 —
D502 DH570 M 20000 212 25.85 0 0 0.00 2149 10 214.90 544409 311 37 47.31 2120 7639 27.75
D503 DH571 S 14721 65 62.05 122 4501 2.71 0 0 0.00 73868 308 11 21.80 0 0 —
D503 DH572 S 11645 200 15.95 0 0 0.00 350 0 0.00 384559 288 13 102.71 3651 4426 82.49
D503 DH573 S 78 30 0.71 0 594 0.00 594 0 0.00 67645 308 5 43.93 0 0 —
D504 DH574 S 27214 72 103.55 157 5955 2.64 0 0 0.00 88615 309 7 40.97 0 0 —
D504 DH575 S 13166 146 24.71 0 0 0.00 1083 8 135.38 457781 308 27 55.05 738 911 81.01
D505 DH576 S 20206 45 123.02 53 6987 0.76 0 0 0.00 14869 294 5 10.11 0 0 —
D505 DH577 S 12977 80 44.44 0 4621 0.00 0 0 0.00 267646 310 7 123.34 0 0 —
D506 DH578 S 24223 137 48.44 840 7596 11.06 1921 5 384.20 811035 0 53 0.00 218 1254 17.38
D507 DH579 S 27340 68 110.15 812 5938 13.67 0 0 0.00 144405 309 14 33.38 0 0 —
D507 DH580 S 27900 100 76.44 406 1286 31.57 1271 6 211.83 192238 0 23 0.00 0 0 —
D507 DH581 S 15209 166 25.10 0 0 0.00 1649 4 412.25 527133 312 30 56.32 1071 3739 28.64
D508 DH582 S 29200 80 100.00 568 3808 14.92 0 0 0.00 58790 307 6 31.92 0 0 —
D508 DH583 S 53250 150 97.26 0 0 0.00 344 3 114.67 276116 307 17 52.91 2582 1995 —
D509 DH584 S 38467 134 78.65 2419 13490 17.93 0 0 0.00 120659 307 7 56.15 0 0 —
D509 DH585 S 0 174 0.00 0 0 0.00 920 12 76.67 520269 309 28 60.13 521 4904 10.62
D510 DH586 L 83533 305 75.04 0 0 0.00 753 5 150.60 574362 309 53 35.07 9 1496 0.60
D510 DH587 S 19557 141 38.00 1075 5499 19.55 0 0 0.00 116578 310 20 18.80 0 0 —
D511 DH588 S 10800 30 98.63 509 3369 15.11 0 2 0.00 54957 309 4 44.46 0 0 —
D511 DH589 S 309 68 1.24 0 0 0.00 543 5 108.60 239011 309 16 48.34 119 611 19.48
D512 DH590 S 365 64 1.56 464 11306 4.10 0 0 0.00 117027 310 12 31.46 0 0 —
D512 DH591 S 365 184 0.54 0 0 0.00 555 5 111.00 461762 310 25 59.58 3717 4554 81.62
D513 DH592 S 17629 70 69.00 0 0 0.00 129 4 32.25 344829 310 16 69.52 98 1180 8.31
D513 DH593 S 4622 30 42.21 234 4591 5.10 0 0 0.00 69989 310 13 17.37 0 0 —
D514 DH594 S 13134 60 59.97 201 5580 3.60 0 0 0.00 85010 0 11 0.00 0 0 —
D514 DH595 S 5704 104 15.03 0 0 0.00 764 4 191.00 540567 309 26 67.28 56 119 47.06
D515 DH596 S 26680 100 73.10 1408 7163 19.66 0 0 0.00 72306 311 12 19.37 533 533 100.00
D515 DH597 S 16537 145 31.25 0 0 0.00 1720 8 215.00 328070 309 26 40.84 2235 5495 40.67

Annexures
185
186

Annexures
D516 DH598 S 16249 47 94.72 577 4647 12.42 0 0 0.00 88146 278 11 28.82 98 182 53.85
D516 DH599 S 54672 172 87.09 0 0 0.00 10464 13 804.92 886104 313 46 61.54 424 1598 26.53
D517 DH600 S 16217 100 44.43 26 823 3.16 501 2 250.50 266846 290 20 46.01 949 2936 32.32

D518 DH601 S 36876 100 101.03 65 3670 1.77 1121 3 373.67 223398 309 36 20.08 349 610 57.21
D519 DH602 S 30802 100 84.39 91 5171 1.76 267 2 133.50 79475 309 33 7.79 340 340 100.00
D520 DH603 L 348 423 0.23 0 0 0.00 4603 7 657.57 501898 0 69 0.00 5778 9078 63.65

D520 DH604 S 15355 68 61.87 0 0 0.00 519 6 86.50 160656 310 19 27.28 0 0 —
D520 DH605 S 20482 100 56.12 415 2886 14.38 869 5 173.80 294497 291 34 29.77 0 0 —
D520 DH606 S 23673 185 35.06 3650 8871 41.15 0 0 0.00 204826 310 22 30.03 0 0 —
D521 DH607 S 0 30 0.00 0 0 0.00 0 3 0.00 0 0 7 0.00 0 0 —
D522 DH608 S 29880 100 81.86 155 2921 5.31 677 5 135.40 269436 309 35 24.91 908 1047 86.72
D523 DH609 S 0 100 0.00 128 3178 4.03 1156 7 165.14 329861 313 42 25.09 1373 1412 97.24
D524 DH610 S 18906 60 86.33 557 8965 6.21 557 1 557.00 156219 0 17 0.00 0 0 —
D524 DH611 S 365 167 0.60 0 0 0.00 1956 6 326.00 386230 310 28 44.50 4821 11052 43.62
D525 DH612 S 28540 60 130.32 978 8134 12.02 0 0 0.00 106904 310 9 38.32 0 0 —
D525 DH613 S 0 140 0.00 0 0 0.00 846 8 105.75 8298 0 25 0.00 475 4094 11.60
D526 DH614 L 113477 376 82.69 0 0 0.00 2979 18 165.50 878968 309 95 29.94 4522 4736 95.48
D526 DH615 L 48855 656 20.40 0 0 0.00 8422 24 350.92 5068250 309 85 192.97 383 4964 7.72
D526 DH616 L 20555 326 17.27 2720 7029 38.70 0 0 0.00 197911 310 43 14.85 0 0 —
D526 DH617 L 0 466 0.00 1876 6471 28.99 5661 16 353.81 1271496 308 87 47.45 1047 12252 8.55
D526 DH618 S 40105 110 99.89 567 1675 33.85 4474 5 894.80 326605 310 38 27.73 0 0 —
D526 DH619 S 24278 100 66.52 2344 4488 52.23 1182 6 197.00 529766 308 48 35.83 0 0 —
D526 DH620 S 9415 82 31.46 1266 2681 47.22 0 0 0.00 86014 310 33 8.41 0 0 —
D526 DH621 S 5202 100 14.25 45 286 15.73 220 4 55.00 199303 306 22 29.61 0 0 —
D526 DH622 S 1442 100 3.95 10 27 37.04 329 5 65.80 137726 310 23 19.32 0 0 —
D527 DH623 S 28020 100 76.77 94 2888 3.25 993 2 496.50 338665 306 28 39.53 803 194 —
D528 DH624 S 8028 30 73.32 92 4033 2.28 0 0 0.00 97962 310 7 45.14 0 0 —
D528 DH625 S 130 100 0.36 0 0 0.00 385 6 64.17 376642 310 20 60.75 145 333 43.54
D529 DH626 S 39990 30 365.21 6 4332 0.14 0 0 0.00 76292 305 5 50.03 0 0 —
D529 DH627 S 19813 100 54.28 0 0 0.00 195 2 97.50 393738 308 19 67.28 960 157 —
D530 DH628 S 14598 54 74.06 407 4855 8.38 0 0 0.00 82725 0 11 0.00 0 0 —
D530 DH629 S 25408 100 69.61 129 710 18.17 502 6 83.67 278530 363 22 34.88 0 0 —
D530 DH630 S 8749 74 32.39 0 0 0.00 1079 7 154.14 439258 325 19 71.13 3140 2852 —
D531 DH631 S 2742 30 25.04 14 850 1.65 0 0 0.00 387070 313 6 206.11 0 0 —
D531 DH632 S 0 70 0.00 0 0 0.00 1656 11 150.55 283618 312 34 26.74 535 801 66.79
D532 DH633 S 20477 116 48.36 1574 4919 32.00 0 0 0.00 313 313 18 0.06 0 0 —
D532 DH634 M 2 250 0.00 0 0 0.00 1787 3 595.67 535315 309 40 43.31 5047 8889 56.78
D533 DH635 S 310 88 0.97 1806 8611 20.97 0 1 0.00 112179 310 11 32.90 0 0 —
D533 DH636 S 0 155 0.00 0 0 0.00 2189 6 364.83 708998 300 44 53.71 0 0 —
D534 DH637 S 60337 187 88.40 0 0 0.00 633 5 126.60 625532 309 39 51.91 3235 4237 76.35
D534 DH638 S 24748 78 86.93 1272 5067 25.10 0 0 0.00 89299 310 6 48.01 0 0 —
D535 DH639 S 43193 127 93.18 3707 11312 32.77 0 0 0.00 186486 312 13 45.98 5881 5881 100.00
D535 DH640 S 56170 175 87.94 0 0 0.00 4361 5 872.20 741875 312 28 84.92 18393 19448 94.58
D536 DH641 S 41444 130 87.34 0 0 0.00 467 1 467.00 347425 310 16 70.05 1549 2199 70.44
D536 DH642 S 10183 70 39.86 246 3105 7.92 246 2 123.00 100024 308 10 32.48 0 0 —
D537 DH643 S 21996 62 97.20 2510 7451 33.69 3197 0 0.00 104087 308 9 37.55 0 0 —

Annexures
187
188

Annexures
D537 DH644 S 662 180 1.01 0 0 0.00 2878 6 479.67 305395 308 22 45.07 978 2443 40.03
D538 DH525 S 56940 156 100.00 0 0 0.00 3390 10 339.00 942139 308 40 76.47 5276 5608 94.08
D538 DH526 S 39550 164 66.07 1534 4581 33.49 0 0 0.00 165166 309 22 24.30 0 0 —

D538 DH527 S 0 199 0.00 0 0 0.00 5059 3 1686.33 934306 309 48 62.99 4283 5148 83.20
D539 DH645 S 0 121 0.00 1928 8295 23.24 518 0 0.00 140464 297 14 33.78 0 0 —
D539 DH646 M 0 248 0.00 0 0 0.00 0 5 0.00 89283 0 28 0.00 617 8320 7.42

D540 DH647 S 69671 150 127.25 0 0 0.00 828 2 414.00 424945 309 15 91.68 3740 4414 84.73
D540 DH648 S 15847 52 83.49 485 3153 15.38 0 0 0.00 123961 304 10 40.78 0 0 —
D541 DH649 S 0 168 0.00 3567 13305 26.81 140 1 140.00 196747 312 19 33.19 0 0 —
D541 DH650 L 104595 320 89.55 0 0 0.00 2788 6 464.67 641890 309 40 51.93 2119 4791 44.23
D542 DH651 S 2723 70 10.66 1 5552 0.02 0 1 0.00 156902 308 5 101.88 0 0 —
D543 DH652 S 23351 100 63.98 112 1250 8.96 514 8 64.25 349220 308 35 32.40 684 761 89.88
D544 DH653 S 15287 100 41.88 0 503 0.00 190 3 63.33 257192 310 20 41.48 247 345 71.59
D544 DH654 S 1550 50 8.49 4 3114 0.13 135 4 33.75 222033 310 18 39.79 0 0 —
D545 DH655 S 365 108 0.93 322 7662 4.20 0 0 0.00 78390 310 14 18.06 0 0 —
D545 DH656 M 365 204 0.49 0 0 0.00 1291 6 215.17 405903 310 28 46.76 4861 5886 82.59
D546 DH657 S 0 100 0.00 16 3117 0.51 50 2 25.00 0 313 14 0.00 102 102 100.00
D547 DH658 S 62081 100 170.08 246 1327 18.54 306 3 102.00 232954 312 27 27.65 2032 2164 93.90
D548 DH659 S 38430 144 73.12 727 13377 5.43 0 0 0.00 202367 295 14 49.00 0 0 —
D548 DH660 S 0 200 0.00 0 0 0.00 1554 5 310.80 769240 295 34 76.69 1673 2870 58.29
D549 DH661 S 16338 100 44.76 61 1341 4.55 606 3 202.00 0 0 20 0.00 4059 4622 87.82
D550 DH662 S 30832 82 103.01 1911 10227 18.69 0 0 0.00 161238 308 11 47.59 0 0 —
D550 DH663 M 61288 210 79.96 0 0 0.00 2074 8 259.25 395428 304 34 38.26 1613 9435 17.10
D551 DH664 S 21971 60 100.32 981 6458 15.19 0 0 0.00 108555 292 18 20.65 0 0 —
D551 DH665 S 9888 110 24.63 0 0 0.00 470 5 94.00 569267 305 31 60.21 726 726 100.00
D552 DH666 S 53088 180 80.80 2381 5874 40.53 0 0 0.00 12042 349 18 1.92 0 0 —
D552 DH667 S 13462 125 29.51 0 0 0.00 2578 3 859.33 428391 310 29 47.65 2469 2469 100.00
D552 DH668 S 2901 153 5.19 70 798 8.77 465 3 155.00 247740 310 25 31.97 0 0 —
D552 DH669 M 77252 286 74.00 0 0 0.00 3999 9 444.33 1301539 309 43 97.96 2732 3433 79.58
D553 DH670 S 9560 36 72.75 160 1121 14.27 0 0 0.00 22335 310 9 8.01 0 0 —
D553 DH671 S 5296 59 24.59 0 0 0.00 0 2 0.00 104506 310 19 17.74 66 858 7.69
D554 DH672 S 17286 45 105.24 68 1349 5.04 97 1 97.00 111905 295 19 19.97 0 21 —
D555 DH673 S 7026 68 28.31 0 643 0.00 10 1 10.00 68279 315 15 14.45 200 230 86.96
D556 DH674 S 2341 45 14.25 0 483 0.00 0 1 0.00 55190 313 11 16.03 0 153 0.00
D557 DH675 S 36500 132 75.76 0 0 0.00 37 3 12.33 169603 310 18 30.39 13 13 100.00
D557 DH676 S 2081 32 17.82 19 637 2.98 0 0 0.00 18085 310 9 6.48 0 0 —
D558 DH677 S 15523 38 111.92 606 4561 13.29 0 0 0.00 82694 308 8 33.56 189 641 29.49
D558 DH678 S 13857 70 54.23 0 0 0.00 288 2 144.00 104393 312 17 19.68 1722 8440 20.40
D559 DH679 S 8744 63 38.03 0 0 0.00 200 5 40.00 132994 0 22 0.00 0 350 0.00
D559 DH680 S 5350 53 27.66 126 718 17.55 0 0 0.00 35538 313 7 16.22 0 0 —
D560 DH681 S 40290 44 250.87 837 3087 27.11 0 0 0.00 74584 309 8 30.17 0 0 —
D560 DH682 S 40290 120 91.99 0 0 0.00 1664 5 332.80 200600 309 26 24.97 113 2176 5.19
D561 DH683 S 298 50 1.63 144 1210 11.90 128 4 32.00 70381 330 16 13.33 0 0 —
D562 DH684 S 485 76 1.75 3 546 0.55 10 4 2.50 99756 270 18 20.53 293 293 100.00
D563 DH685 S 21338 125 46.77 11 3579 0.31 180 3 60.00 287784 310 11 84.39 707 5976 11.83
D564 DH686 S 12000 108 30.44 0 0 0.00 1521 2 760.50 93000 300 14 22.14 0 491 0.00

Annexures
189
190

Annexures
D564 DH687 S 1200 50 6.58 69 1996 3.46 1521 2 760.50 93000 300 14 22.14 578 491 —
D565 DH688 M 161555 282 156.96 3316 7528 44.05 2001 8 250.13 385619 0 55 0.00 2699 14721 18.33
D566 DH689 M 140897 286 134.97 1633 8002 20.41 202 5 40.40 0 0 58 0.00 0 8100 0.00

D567 DH690 L 147737 430 94.13 1865 5742 32.48 595 7 85.00 371794 0 49 0.00 1056 4411 23.94
D568 DH691 L 126870 365 95.23 1408 5919 23.79 2437 7 348.14 488431 303 61 26.43 25 3046 0.82
D568 DH692 L 65276 343 52.14 511 1975 25.87 337 4 84.25 113941 300 37 10.26 2213 2213 100.00

D569 DH693 L 230368 636 99.24 2458 5936 41.41 851 9 94.56 325454 0 71 0.00 0 9259 —
D570 DH694 L 261906 625 114.81 4668 9188 50.81 978 4 244.50 362606 303 72 16.62 0 9692 0.00
D571 DH695 L 161724 700 63.30 3636 11004 33.04 1626 11 147.82 396491 305 67 19.40 4217 14917 28.27
D572 DH696 L 137160 460 81.69 2056 6604 31.13 499 8 62.38 266792 355 73 10.29 193 5070 3.81
D573 DH697 L 136903 500 75.02 3129 9036 34.63 863 8 107.88 524329 0 57 0.00 3345 13957 23.97
D574 DH698 L 267421 849 86.30 7819 14223 54.97 860 10 86.00 408158 303 76 17.72 266 16911 1.57
D575 DH699 L 253662 600 115.83 2766 10959 25.24 1552 13 119.38 1143611 299 66 57.95 15 10077 0.15
D575 DH700 L 120435 549 60.10 1733 7231 23.97 578 10 57.80 246332 301 34 24.07 357 6202 5.76
D576 DH701 L 181133 405 122.53 2837 9004 31.51 1160 10 116.00 245859 303 66 12.29 2051 86831 2.36
D577 DH702 L 184288 415 121.66 4387 10160 43.18 598 8 74.75 371714 303 62 19.79 461 21550 2.14
D577 DH703 S 23116 70 90.47 32 1700 1.88 2 3 0.67 192266 303 35 18.13 0 0 —
D578 DH704 L 280144 590 130.09 3615 13243 27.30 2129 7 304.14 453160 302 89 16.86 1884 8012 23.51
D579 DH705 L 226293 625 99.20 3409 5571 61.19 4578 6 763.00 645275 303 104 20.48 5069 32 —
D579 DH706 L 186232 427 119.49 3769 9996 37.71 596 9 66.22 540280 0 60 0.00 0 14841 0.00
D580 DH707 L 118549 436 74.49 1697 9747 17.41 584 8 73.00 273373 0 51 0.00 3955 12801 30.90
Annexures
ANNEXURE 7 - TABLE 7C - DISTRICT AND DISTRICT HOSPITAL CODES
District
District DH Code District Hospital (DH)
Code
Andaman and Nicobar Islands
D1 Nicobar DH1 BJR Hospital
D2 North and Middle Andaman DH2 Dr R.P. Hospital
D3 South Andaman DH3 G.B. Pant Hospital
Andhra Pradesh
D4 Anantapur DH4 Ggh Anantapur
D5 Chittoor DH5 GovernmentMaternity Hospl.Th
Sri.Venkateshwara Ram Narayana Ruia Gen.
D5 Chittoor DH6
Hospl.Th
D6 Cuddapah DH7 DH Proddutur
D7 East Godavari DH8 DH Rajahmundry
D8 Guntur DH9 DH Tenali
D9 Krishna DH10 DH Machilipatnam
D10 Kurnool DH11 DH Nandyal
D11 Nellore DH12 Government General Hospital Nellore
D12 Prakasam DH13 Rims Ongole Th
D13 Srikakulam DH14 Rims Srikakulam Th
D14 Vishakapatnam DH15 King George Hospital Th
D15 Vizianagaram DH16 DH Vizianagaram
D16 West Godavari DH17 DH Eluru
Arunachal Pradesh
D17 East Siang DH18 GH Pasighat
D18 Lohit DH19 GH Tezu
D19 Lower Dibang Valley DH20 DH Roing
Tomo Riba Institute Of Medical Science &
D20 Papum Pare DH21
Hospital
D21 Tawang DH22 DH Tawang
D22 West Siang DH23 General Hospital Aalo
Assam
D23 Baksa DH24 Dr Ravi Boro Civil Hospital Baksa
D24 Barpeta DH25 Barpeta Civil Hospital Kalgachia
D25 Bongaigaon DH26 Bongaigaon Ch
D26 Cachar DH27 S.M.Deb Civil Hospital Silchar
D27 Chirang DH28 J.S.B Civil Hospital Chirang
D28 Darrang DH29 Mangaldai Civil Hospital
D29 Dhemaji DH30 DHemaji Civil Hospital
D30 Dhubri DH31 DHubri Civil Hospital

Annexures
District
Code
D31 Dima Hasao DH32 Haflong Civil Hospital
D32 Goalpara DH33 200 Bedded Civil Hospital
D33 Golaghat DH34 Kushal Konwar Civil Hospital
D34 Hailakandi DH35 S.K.Roy Civil Hospital
D35 Kamrup M DH36 Sonapur District Hospital
D36 Kamrup R DH37 Trb Civil Hospital
D37 Karbi Anglong DH38 Diphu Civil Hospital
D38 Karimganj DH39 Karimganj Civil Hospital
D39 Kokrajhar DH40 Rnb Civil Hospital Kokrajhar
D40 Lakhimpur DH41 North Lakhimpur Civil Hospital
D41 Marigaon DH42 Morigaon Civil Hospital
D42 Nagaon DH43 B.P. Civil Hospital
D43 Nalbari DH44 Smk Civil Hospital
D44 Sibsagar DH45 Sivasagar Civil Hospital
D45 Sonitpur DH46 Kanaklata Civil Hospital
D46 Tinsukia DH47 LGB Civil Hospital
D47 Udalguri DH48 Udalguri Civil Hospital
Bihar
D48 Araria DH49 Sardar Hospital Araria
D49 Arwal DH50 Sadar Hospital Arwal
D50 Aurangabad DH51 Sadar Hospital Aurangabad
D51 Banka DH52 Sadar Hospital Banka
D52 Begusarai DH53 Sadar Hospital Begusarai
D53 Bhagalpur DH54 LNJP Sadar Hospital Bhagalpur
D54 Bhojpur DH55 Sadar Hospital Ara Bhojpur
D55 Buxar DH56 Sadar Hospital Buxar
D56 East Champaran DH57 Sadar Hospital Motihari Purbi Champaran
D57 Gaya DH58 Sadar Hospital Pilgrim Gaya
D58 Gopalganj DH59 Sadar Hospital Gopalganj
D59 Jamui DH60 Sadar Hospital Jamui
D60 Jehanabad DH61 Sadar Hospital Jehanabad
D61 Kaimur Bhabua DH62 Sadar Hospital Bhabua Kaimur
D62 Katihar DH63 Sadar Hospital Katihar
D63 Khagaria DH64 Sadar Hospital Khagaria
D64 Kishanganj DH65 Sadar Hospital Kishanganj
D65 Lakhisarai DH66 Sadar Hospital Lakhisarai
D66 Madhepura DH67 Sadar Hospital Madhepura
D67 Madhubani DH68 Sadar Hospital Madhubani
D68 Munger DH69 Sadar Hospital Munger

Annexures
District
Code
D69 Muzaffarpur DH70 Sadar Hospital Muzaffarpur
D70 Nalanda DH71 Sadar Hospital Biharsharif Nalanda
D71 Nawada DH72 Sadar Hospital Nawada
D72 Purnia DH73 Sadar Hospital Purnia
D73 Rohtas DH74 Sadar Hospital Rohtas Sasaram
D74 Saharsa DH75 Sadar Hospital Saharsa
D75 Samastipur DH76 Sadar Hospital Samastipur
D76 Saran DH77 Sadar Hospital Saran
D77 Sheikhpura DH78 Sadar Hospital Sheikhpura
D78 Sheohar DH79 Sadar Hospital Sheohar
D79 Sitamarhi DH80 Sadar Hospital Sitamarhi
D80 Siwan DH81 Sadar Hospital Siwan
D81 Supaul DH82 Sadar Hospital Supaul
D82 Vaishali DH83 Sadar Hospital Hajipur Vaishali
Sadar Hospital M.J.K Bettiah Paschim
D83 West Champaran DH84
Champaran
Chandigarh
D84 Chandigarh DH85 GMSH 16
Chhattisgarh
D85 Balod DH86 DH Balod
D86 Baloda Bazar DH87 DH Baloda Bazar
D87 Bemetra DH88 DH Bemetara
D88 Bilaspur DH89 Bilaspur DH
D89 Dantewada DH90 Dantewada
D90 Dhamtari DH91 DHamtari
D91 Durg DH92 District Hospital Durg
D92 Gariyaband DH93 DH Gariaband
D93 Janjgir Champa DH94 District Hospital
D94 Jashpur DH95 Jashpur
D95 Kanker DH96 Kanker DH
D96 Kawardha DH97 District Hospital Kawardha
D97 Kondagaon DH98 Ravindra Tagore DH Kondagaon
D98 Korba DH99 Indira Gandhi Dstt Hospital Korba
D99 Mahasamund DH100 Mahasamund
D100 Mungeli DH101 DH Mungeli
D101 Narayanpur DH102 Narayanpur
D102 Raipur DH103 Raipur
D103 Sukma DH104 DH Sukma

Annexures
District
Code
Dadra and Nagar Haveli
D104 Dadra and Nagar Haveli DH105 Shri Vinoba Bhave Civil Hospital
Daman and Diu
D105 Daman DH106 Government Hospital Daman
D106 Diu DH107 Government Hospital Diu
Delhi
D107 Delhi Central DH108 Aruna Asaf Ali Hospital
D107 Delhi Central DH109 Girdhari Lal Maternity Hospital
D107 Delhi Central DH110 Kasturba Hospital
D108 Delhi East DH111 Lal Bahadur Shastri Hospital
Babu Jagjeevan Ram Memorial Hospital
D109 Delhi North DH112
Jahgirpuri
D109 Delhi North DH113 Maharishi Valmiki Hospital
D109 Delhi North DH114 Satyawati Raja Harishchandra Hospital
D110 Delhi North East DH115 DH Jpc Hospital
D111 Delhi North West DH116 Deep Chand Bandhu Hospital
D111 Delhi North West DH117 Sanjay Gandhi Memorial Hospital Mangolpuri
D111 Delhi North West DH118 Bhagwan Mahavir Hospital Pitampura
D112 Delhi South DH119 Pt. Madan Mohan Malviya Hospital
D113 Delhi South West DH120 Rao Tula Ram Hospital
D114 Delhi West DH121 Guru Govind Singh Govt Hospital
D114 Delhi West DH122 Acharya Shree Bhikshu Hospital
D114 Delhi West DH123 Deendayal Upadhyay Hospital
D115 Shahdara DH124 Hedgewar Hospital
D115 Shahdara DH125 DH SDN Hospital
Goa
D116 North Goa DH126 North Goa District Hospital
D117 South Goa DH127 South Goa District Hospital
Gujarat
D118 Amreli DH128 General Hospital Amreli
D119 Anand DH129 S.S.Hospital Petlad
D120 Banas Kantha DH130 General Hospital Palanpur
D121 Bharuch DH131 General Hospital Bahruch
D122 Botad DH132 Botad
D123 Chhotaudepur DH133 Chhotaudepur
D124 Dahod DH134 General Hospital Dahod
D125 Devbhumi Dwarka DH135 Jam Khambhalia
D126 Kheda DH136 General Hospital Nadiad
D127 Mahesana DH137 General Hospital Mehsana

Annexures
District
Code
D128 Mahisagar DH138 Lunawada
D129 Morbi DH139 Morbi
D130 Narmada DH140 General Hospital Rajpipla
D131 Navsari DH141 M.G.G.Hospital Navsari
D132 Panch Mahals DH142 General Hospital Godhra
D133 Porbandar DH143 Bhavsinhji General Hospital
D134 Rajkot DH144 PK General Hospital
D135 Surendranagar DH145 M.G. General Hospital
D136 Tapi DH146 General Hospital Vyara
D137 The Dangs DH147 General Hospital Dang
D138 Vadodara DH148 Jamnabai General Hospital
Haryana
D139 Ambala DH149 Civil Hospital
D140 Bhiwani DH150 Civil Hospital
D141 Faridabad DH151 B.K. Civil Hospital
D142 Fatehabad DH152 Civil Hospital Fatehabad
D143 Hisar DH153 Civil Hospital
D144 Jhajjar DH154 Civil Hospital Jhajjar
D145 Jind DH155 Civil Hospital Jind
D146 Kaithal DH156 IGMS Civil Hospital
D147 Kurukshetra DH157 LNJP Civil Hospital
D148 Mahendragarh DH158 Civil Hospital
D149 Mewat DH159 Civil Hospital Mandikhera
D150 Palwal DH160 Civil Hospital
D151 Panchkula DH161 Civil Hospital
D152 Panipat DH162 Civil Hospital
D153 Rewari DH163 Civil Hospital Rewari
D154 Rohtak DH164 Civil Hospital
D155 Sirsa DH165 Civil Hospital Sirsa
D156 Sonipat DH166 Civil Hospital Sonepat
Himachal Pradesh
D157 Bilaspur DH167 Bilaspur RH
D158 Chamba DH168 Chamba RH MCH Centre
D159 Hamirpur DH169 Hamirpur RH
D160 Kangra DH170 DHaramshala ZH
D161 Kullu DH171 Kullu RH
D162 Lahul Spiti DH172 Keylong RH
D163 Mandi DH173 Mandi ZH
D164 Shimla DH174 DDU ZH

Annexures
District
Code
D165 Sirmaur DH175 Nahan RH
D166 Solan DH176 Solan RH
D167 Una DH177 Una RH
Jammu and Kashmir
D168 Anantnag DH178 MCH Anantnag
D168 Anantnag DH179 DH Anantnag
D169 Badgam DH180 District Hospital Budgam
D170 Bandipora DH181 Bandipora
D171 Baramula DH182 Baramula
D172 Doda DH183 Doda
D173 Ganderbal DH184 District Hospital
D174 Jammu DH185 Gandhinagar Hospital
D174 Jammu DH186 Sarwal Hospital
D175 Kathua DH187 Kathua
D176 Kulgam DH188 Kulgam
D177 Kupwara DH189 DH Handwara
D178 Pulwama DH190 Pulwama DH
D179 Ramban DH191 Ramban
D180 Reasi DH192 DH Reasi
D181 Samba DH193 Samba
D182 Shopian DH194 Shopain
D183 Srinagar DH195 District Hospital Jnlm
D184 Udhampur DH196 Udhampur
Jharkhand
D185 Bokaro DH197 Bokaro Sadar Hospital
D186 Chatra DH198 Chatra Sadar Hospital
D187 Deoghar DH199 Deoghar Sadar Hospital
D188 Dumka DH200 Dumka Sadar Hospital
D189 Garhwa DH201 Garhwa Sadar Hospital
D190 Giridih DH202 Giridih Sadar Hospital
D191 Godda DH203 Godda Sadar Hospital
D192 Gumla DH204 Gumla Sadar Hospital
D193 Hazaribagh DH205 Hazaribagh Sadar Hospital
D194 Jamtara DH206 Jamtara Sadar Hospital
D195 Khunti DH207 Khunti Sadar Hospital
D196 Kodarma DH208 Kodrma Sadar Hospital
D197 Latehar DH209 Latehar Sadar Hospital
D198 Lohardaga DH210 Lohardaga Sadar Hospital
D199 Pakur DH211 Pakur Sadar Hospital

Annexures
District
Code
D200 Palamu DH212 Palamau Sadar Hospital
D201 Pashchimi Singhbhum DH213 Pashchimi Singhbhum Sadar Hospital
D202 Purbi Singhbhum DH214 Purbi Singhbhum Sadar Hospital
D203 Ramgarh DH215 Ramgarh Sadar Hospital
D204 Ranchi DH216 Ranchi Sadar Hospital
D205 Sahibganj DH217 Sahibganj Sadar Hospital
D206 Saraikela DH218 Saraikela Sadar Hospital
D207 Simdega DH219 Simdega Sadar Hospital
Karnataka
D208 Bagalkote DH220 Bagalkote District Hospital FRU
D209 Bangalore Urban DH221 HSIS Goshiya
D209 Bangalore Urban DH222 Indiranagar General Hospital
D209 Bangalore Urban DH223 Jayanagar General Hospital
D209 Bangalore Urban DH224 Vanivilas Hospital
D209 Bangalore Urban DH225 Victoria Hospital
D209 Bangalore Urban DH226 Kc General Hospital
D209 Bangalore Urban DH227 Bowring Lady Curzon
D210 Belgaum DH228 Belgaum District Hospital
D211 Bellary DH229 Bellary District Hospital FRU
D211 Bellary DH230 Vims Bellary Medical College
D212 Bidar DH231 Bidar District Hospital
D213 Bijapur DH232 Bijapur District Hospital FRU
D214 Chamrajnagar DH233 Chamarajnagar District Hospital FRU
D215 Chikkaballapur DH234 Chikkaballapur District Hospital FRU
D216 Chikmagalur DH235 Chickmagalur District Hospital FRU
D217 Chitradurga DH236 Chitradurga District Hospital FRU
D218 Dakshina Kannada DH237 Lady Goshan Hospital Mangalore DH FRU
D218 Dakshina Kannada DH238 Wenlock Hospital Mangalore DH
D219 Davanagere DH239 Davangere Women And Children DH FRU
D219 Davanagere DH240 Davanagere District Hospital
D220 Dharwad DH241 DHarwad District Hospital FRU
D220 Dharwad DH242 Hubli Kims District Hospital
D221 Gadag DH243 Gadag District Hospital FRU
D222 Gulbarga DH244 Gulbarga District Hospital FRU
D223 Hassan DH245 Hassan District Hospital
D224 Haveri DH246 Haveri District Hospital FRU
D225 Kodagu DH247 Kodagu District Hospital FRU
D226 Kolar DH248 Kolar District Hospital FRU
D227 Koppal DH249 Koppal District Hospital FRU

Annexures
District
Code
D228 Mandya DH250 Mandya District Hospital
D229 Mysore DH251 Cheluvamba Hospital Mysore DH
D229 Mysore DH252 KR Hospital Mysore DH
D230 Raichur DH253 Raichur District Hospital
D231 Ramanagar DH254 Ramanagara District Hospital FRU
D232 Shimoga DH255 Shimoga District Hospital
D233 Tumkur DH256 Tumkur District Hospital FRU
D234 Udupi DH257 Udupi District Hospital FRU
D235 Uttara Kannada DH258 Uttara Kannada District Hospital FRU
D236 Yadgir DH259 Yadgir District Hospital FRU
Kerala
D237 Alappuzha DH260 W And C Hospital Alappuzha
D237 Alappuzha DH261 General Hospital Alappuzha
D238 Ernakulam DH262 DH Aluva
D238 Ernakulam DH263 GH Ernakulam
D239 Idukki DH264 District Hospital Thodupuzha
D240 Kannur DH265 GH Thalassery
D241 Kasaragod DH266 DH Kanhangad
D242 Kollam DH267 W&C Hospital Kollam
D242 Kollam DH268 DH Kollam
D243 Kottayam DH269 General Hospital Kottayam
D244 Kozhikode DH270 General Hospital Calicut
D245 Malappuram DH271 DH Tirur
D245 Malappuram DH272 GH Manjeri
D246 Palakkad DH273 W & C Palakkad
D246 Palakkad DH274 District Hospital Palakkad
D247 Pathanamthitta DH275 General Hosp Pathanamthitta
D248 Thiruvananthapuram DH276 District Model Hospital Peroorkada
D248 Thiruvananthapuram DH277 General Hospital Thiruvananthapuram
D248 Thiruvananthapuram DH278 W&C Hospital Thiruvananthapuram
D249 Thrissur DH279 GH Thrissur
D250 Wayanad DH280 DH Mananthavady
Ladakh
D251 Kargil DH281 Kargil
D252 Leh DH282 Leh DH
Lakshadweep
D253 Lakshadweep DH283 Indira Gandhi Hospital
Madhya Pradesh
D254 Agar Malwa DH284 DH Agar

Annexures
District
Code
D255 Alirajpur DH285 DH Alirajpur
D256 Anuppur DH286 DH Anuppur
D257 Ashok Nagar DH287 DH Ashoknagar
D258 Balaghat DH288 DH Balaghat
D259 Barwani DH289 DH Barwani
D260 Betul DH290 DH Betul
D261 Bhind DH291 DH Bhind
D262 Bhopal DH292 DH Bhopal J.P
D263 Burhanpur DH293 DH Burhanpur
D264 Chhatarpur DH294 DH Chhatarpur
D265 Chhindwada DH295 DH Chhindwara
D266 Damoh DH296 DH Damoh
D267 Datia DH297 DH Datia
D268 Dewas DH298 DH Dewas
D269 Dhar DH299 DH DHar
D270 Dindori DH300 DH Dindori
D271 Guna DH301 DH Guna
D272 Gwalior DH302 DH Gwalior
D273 Harda DH303 DH Harda
D274 Hoshangabad DH304 DH Hoshangabad
D275 Indore DH305 DH Indore
D276 Jabalpur DH306 DH Jabalpur
D277 Jhabua DH307 DH Jhabua
D278 Katni DH308 DH Katni
D279 Khandwa DH309 DH Khandwa
D280 Khargone DH310 DH Khargone
D281 Mandla DH311 DH Mandla
D282 Mandsaur DH312 DH Mandsaur
D283 Morena DH313 DH Morena
D284 Narsinghpur DH314 DH Narsinghpur
D285 Neemuch DH315 DH Neemuch
D286 Panna DH316 DH Panna
D287 Raisen DH317 DH Raisen
D288 Rajgarh DH318 DH Rajgarh
D289 Ratlam DH319 DH Ratlam
D290 Rewa DH320 DH Rewa
D291 Sagar DH321 DH Sagar
D292 Satna DH322 DH Satna
D293 Sehore DH323 DH Sehore

Annexures
District
Code
D294 Seoni DH324 DH Seoni
D295 Shahdol DH325 DH Shahdol
D296 Shajapur DH326 DH Shajapur
D297 Sheopur DH327 DH Sheopur
D298 Shivpuri DH328 DH Shivpuri
D299 Sidhi DH329 DH Sidhi
D300 Singroli DH330 DH Singrauli
D301 Tikamgarh DH331 DH Tikamgarh
D302 Ujjain DH332 DH Ujjain
D303 Umaria DH333 DH Umaria
D304 Vidisha DH334 DH Vidisha
Maharashtra
D305 Ahmednagar DH335 Ahmednagar
D306 Amravati DH336 District General Hospital Amravati
D306 Amravati DH337 District Women Hospital Amravati
D307 Beed DH338 District Hospital Beed
D308 Bhandara DH339 Bhandara
D309 Buldana DH340 DH Buldana
D310 Gadchiroli DH341 District Hospital Gadchiroli
D311 Hingoli DH342 DH Hingoli
D312 Jalgaon DH343 District Hospital Jalgaon
D313 Jalna DH344 Women Hospital Jalna
D313 Jalna DH345 District Hospital Jalna
D314 Nandurbar DH346 Nandurbar
D315 Nashik DH347 District Hospital Nashik
D316 Osmanabad DH348 District Hospital Osmanabad
D316 Osmanabad DH349 WH Osmanabad
D317 Parbhani DH350 General Hospital Parbhani
D317 Parbhani DH351 Women Hospital Parbhani
D318 Pune DH352 Aundh
D319 Raigarh DH353 Alibag
D320 Ratnagiri DH354 District Hospital Ratnagiri
D321 Satara DH355 Lt Karntisigh Nana Patil Civil Hospital Satara
D322 Sindhudurg DH356 Sindhudurg
D323 Thane DH357 District Hospital Thane
D324 Wardha DH358 Wardha
D325 Washim DH359 Washim
Manipur
D326 Bishnupur DH360 Bishnupur District Hospital

Annexures
District
Code
D327 Chandel DH361 Chandel District Hospital
D328 Churachandpur DH362 Churachandpur District Hospital
D329 Senapati DH363 Senapati District Hospital
D330 Tamenglong DH364 Tamenglong District Hospital
D331 Thoubal DH365 Thoubal District Hospital
D332 Ukhrul DH366 Ukhrul District Hospital
Meghalaya
D333 East Garo Hills DH367 Williamnagar Civil Hospital
D334 East Khasi Hills DH368 Ganesh Das Hospital
D334 East Khasi Hills DH369 Shillong Civil Hospital
D335 Ri Bhoi DH370 Nongpoh DH
D336 West Garo Hills DH371 Tura Maternity And Child Hospital
D336 West Garo Hills DH372 Tura Civil Hospital
D337 West Jaintia Hills DH373 Jowai Civil Hospital
D338 West Khasi Hills DH374 Nongstoin DH
D338 West Khasi Hills DH375 Mairang DH
Mizoram
D339 Aizawl West DH376 Aizawl Civil Hospital
D340 Champhai DH377 Champhai DH
D341 Kolasib DH378 Kolasib DH
D342 Lawngtlai DH379 Lawngtlai DH
D343 Lunglei DH380 Lunglei DH
D344 Mamit DH381 Mamit DistrictHospital
D345 Saiha DH382 Saiha DH
D346 Serchhip DH383 Serchhip DH
Nagaland
D347 Dimapur DH384 District Hospital
D348 Mokokchung DH385 Ongpangkong DH
D349 Wokha DH386 Wokha DH
Odisha
D350 Anugul DH387 Angul
D351 Balangir DH388 Balangir
D352 Baleshwar DH389 Balasore
D353 Bargarh DH390 Bargarh
D354 Baudh DH391 Boudh
D355 Bhadrak DH392 Bhadrak
D356 Cuttack DH393 City Hospital
D357 Deogarh DH394 Deogarh
D358 Dhenkanal DH395 DHenkanal

Annexures
District
Code
D359 Gajapati DH396 Paralakhemundi
D360 Ganjam DH397 City Hospital
D361 Jagatsinghpur DH398 Jagatsinghpur
D362 Jajapur DH399 Jajpur
D363 Jharsuguda DH400 Jharsuguda
D364 Kalahandi DH401 Bhawanipatna
D365 Kandhamal DH402 Phulbani
D366 Kendrapara DH403 Kendrapada
D367 Keonjhar DH404 Keonjhar
D368 Khordha DH405 Capital Hospital
D368 Khordha DH406 Khordha
D369 Koraput DH407 DHh Koraput
D370 Malkangiri DH408 Malkangiri
D371 Mayurbhanj DH409 Baripada
D372 Nabarangapur DH410 Nabarangpur
D373 Nayagarh DH411 Nayagarh
D374 Nuapada DH412 Nuapada
D375 Puri DH413 Puri
D376 Rayagada DH414 Rayagada
D377 Sambalpur DH415 Sambalpur
D378 Sonapur DH416 Subarnapur
D379 Sundargarh DH417 Rgh Rourkela
D379 Sundargarh DH418 Sundargarh
Puducherry
D380 Karaikal DH419 Government General Hospital
D381 Mahe DH420 Government General Hospital
D382 Pondicherry DH421 RGGW & CH
D383 Yanam DH422 Government General Hospital
Punjab
D384 Amritsar DH423 Amritsar DH
D385 Barnala DH424 Barnala DH
D386 Bathinda DH425 Bathinda DH
D387 Faridkot DH426 Faridkot DH
D388 Fatehgarh Sahib DH427 Fatehgarh Sahib DH
D389 Fazilka DH428 Fazilka DH
D390 Firozpur DH429 Ferozepur DH
D391 Gurdaspur DH430 Gurdaspur DH
D392 Hoshiarpur DH431 Hoshiarpur DH
D393 Jalandhar DH432 Jalandhar DH

Annexures
District
Code
D394 Kapurthala DH433 Kapurthala DH
D395 Ludhiana DH434 Ludhiana DH
D396 Mansa DH435 Mansa DH
D397 Moga DH436 Moga DH
D398 Mohali SAS Nagar DH437 Mohali DH
D399 Muktsar DH438 Muktsar DH
D400 Nawanshahr DH439 Nawanshahar DH
D401 Pathankot DH440 Pathankot DH
D402 Patiala DH441 M.K.H. Patiala DH
D403 Rupnagar DH442 Rupnagar DH
D404 Sangrur DH443 Sangrur DH
D405 Tarn Taran DH444 Tarn Taran DH
Rajasthan
D406 Ajmer DH445 A K Hospital Beawar Ajmer
D407 Alwar DH446 Rajeev Gandhi Govt Genaral Hospital Alwar
D408 Banswara DH447 District Hospital Banswara
D409 Baran DH448 District Hospital Baran
D410 Barmer DH449 District Hospital Barmar
D411 Bharatpur DH450 RBM Hospital, Bharatpur
D412 Bhilwara DH451 M G Hospital Bhilwara
Pandit Briz Sundar Sharma General Hospital
D413 Bundi DH452
Bundi
D414 Chittaurgarh DH453 District Hospital Chittaurgarh
D415 Churu DH454 D B Government Hospital Churu
D416 Dausa DH455 District Hospital Dausa
D417 Dhaulpur DH456 Sadar Hospital DHolpur
D418 Dungarpur DH457 Shri Hari Dev Joshi Genaral Hospital Dungarpur
D419 Ganganagar DH458 Govt Hospitls Sriganganagar
D420 Hanumangarh DH459 DH Hanumangarh Town
D421 Jaisalmer DH460 Jawahar Hospital Jaisalmer
D422 Jalor DH461 District Hospital Jalor
D423 Jhunjhunun DH462 B.D.K. Hospital Jhunjhunun
D424 Karauli DH463 General Hospital Karauli
D425 Nagaur DH464 District Hospital Nagaur
D426 Pali DH465 Govt Bangur Hopital Pali
D427 Pratapgarh DH466 District Hospital Pratapgarh
D428 Rajsamand DH467 RK District Hospital Rajsamand
D429 Sawai Madhopur DH468 General Hospital Sawai Madhopur
D430 Sikar DH469 S K Hospital, Sikar

Annexures
District
Code
D431 Sirohi DH470 General Hospital Sirohi
D432 Tonk DH471 District Sahadat Hospital Tonk
Sikkim
D433 Sikkim East DH472 Singtam Hospital
D434 Sikkim North DH473 Mangan Hospital
D435 Sikkim South DH474 Namchi District Hospital
D436 Sikkim West DH475 District Hospital Gyalshing
Tamil Nadu
D437 Ariyalur DH476 Ariyalur
D438 Chennai DH477 Kilpauk Hospital
D439 Coimbatore DH478 Pollachi
D440 Cuddalore DH479 Cuddalore
D441 Dharmapuri DH480 Pennagaram
D442 Dindigul DH481 Dindigul
D443 Erode DH482 Erode
D444 Kancheepuram DH483 Kancheepuram
D445 Kanniyakumari DH484 Padhmanabapuram
D446 Karur DH485 Kulithalai
D447 Krishnagiri DH486 Krishnagiri
D448 Madurai DH487 Usilampatti
D449 Nagapattinam DH488 Nagapattinam
D450 Namakkal DH489 Namakkal
D451 Nilgiris DH490 Uthagamandalam
D452 Perambalur DH491 Perambalur
D453 Pudukkottai DH492 Aranthangi
D454 Ramanathapuram DH493 Ramanathapuram
D455 Salem DH494 Mettur Dam
D456 Sivaganga DH495 Karaikudi
D457 Thanjavur DH496 Kumbakonam
D458 Theni DH497 Periakulam
D459 Thiruvallur DH498 Thiruvallur
D460 Thiruvarur DH499 Mannargudi
D461 Tiruchirappalli DH500 Manapparai
D462 Tirunelveli DH501 Tenkasi
D463 Tirupur DH502 Tiruppur
D464 Tiruvanamalai DH503 Cheyyar
D465 Toothukudi DH504 Kovilpatti
D466 Vellore DH505 Walajapet
D467 Viluppuram DH506 Kallakurichi

Annexures
District
Code
D468 Virudhunagar DH507 Virudhunagar
Telangana
D469 Hyderabad DH508 Kingkoti
D470 Karim Nagar DH509 Karimnagar
D471 Khammam DH510 DH Khammam
D472 Nalgonda DH511 Nalgonda
D473 Sangareddy DH512 DH Sangareddy
D474 Vikarabad DH513 Tandur
Tripura
D475 Dhalai DH514 DHalai District Hospital
D476 Gomati DH515 District Hospital Gomati District
D477 Khowai DH516 Khowai District Hospital
D478 North Tripura DH517 District Hospital North Tripura
D479 South Tripura DH518 District Hospital South
D480 Unakoti DH519 District Hospital Unakoti District
Uttar Pradesh
D481 Agra DH520 DH Male
D481 Agra DH521 DH Female
D482 Aligarh DH522 Pt Deen Dayal District Combined Hospital
D482 Aligarh DH523 Mohan Lal Gautam District Female Hospital
D482 Aligarh DH524 Malkhan Singh District Hospital
D483 Ambedkar Nagar DH528 Mahatma Jyotiba Phule District Hospital
D484 Auraiya DH529 District Combined Hospital Auraiya
D484 Auraiya DH530 District Combined Hospital Chicholi
D485 Azamgarh DH531 District Women Hospital
D485 Azamgarh DH532 District Hospital Azamgarh
D486 Bagpat DH533 District Combined Hospital
D487 Bahraich DH534 District Women Hosp
D487 Bahraich DH535 District Male Hosp
D488 Ballia DH536 District Male Hospitol Ballia
D488 Ballia DH537 District Fimale Hospitol Ballia
D489 Balrampur DH538 District Women Hospital
D489 Balrampur DH539 District Memeorial Male Hospital
D489 Balrampur DH540 District Combined Hospital
D490 Banda DH541 DWH Banda
D490 Banda DH542 DH Banda
D491 Barabanki DH543 DWH Barabanki
D491 Barabanki DH544 DH Barabanki
D492 Bareilly DH545 District Male Hospital

Annexures
District
Code
D492 Bareilly DH546 District Female Hospital
D493 Basti DH547 District Female Hospital
D493 Basti DH548 District Male Hospital
D493 Basti DH549 Opec Hospital Kaily
Pandit Deendayal Upadyaya District Combined
D494 Bijnor DH550
Hospital Bijnor Male
Pandit Deendayal Upadyaya District Combined
D494 Bijnor DH551
Hospital Bijnor Female
D495 Budaun DH552 District Female Hospital Budaun
D495 Budaun DH553 District Hospital Badaun
D496 Bulandshahar DH554 K.M.C Bulandshahr
D496 Bulandshahar DH555 Joint Hospital Sikandrabad
D496 Bulandshahar DH556 Ssmj Hospital Khurja
D496 Bulandshahar DH557 B.B.D.Government Hospital
D497 Chandauli DH558 Pt K P T DistrictCombined Hospital Chandauli
D497 Chandauli DH559 Rajkiya Mahila Chikitsalaya Mughalsarai
D497 Chandauli DH560 Combined Hospital Chakiya Chandauli
D498 Chitrakoot DH561 District Combined Hospital
D499 Deoria DH562 District Hospital Female
D499 Deoria DH563 District Hospital Male
D500 Etah DH564 Distt Male Hospital
D500 Etah DH565 District Women Hospital
D501 Etawah DH566 District Women Hospital F
D501 Etawah DH567 District Male Hospital
D502 Faizabad DH568 DistrictFemale Hospital
D502 Faizabad DH569 Sri Ram Ayodya
D502 Faizabad DH570 Distt Male Hospital
D503 Farrukhabad DH571 Dr Ram Manohar Lohiya Female
D503 Farrukhabad DH572 Dr Ram Manohar Lohiya Male
D503 Farrukhabad DH573 Civil Hospital Linziganj
D504 Fatehpur DH574 District Hospital Female
D504 Fatehpur DH575 District Hospital Male
D505 Firozabad DH576 District Women Hospital
D505 Firozabad DH577 Rnm District Joint Hospital
D506 Gautam Buddha Nagar DH578 Combined Distt Hospital Noida
D507 Ghaziabad DH579 District Women Hospital
D507 Ghaziabad DH580 District Combined Hospital Sanjay Nagar
D507 Ghaziabad DH581 District Mmg Male Hospital
D508 Ghazipur DH582 District Woman Hospital

Annexures
District
Code
D508 Ghazipur DH583 District Hospital
D509 Gonda DH584 DWH
D509 Gonda DH585 DH
D510 Gorakhpur DH586 Neta Ji Subhash Chandra Bose District Hospital
D510 Gorakhpur DH587 District Women Hospital
D511 Hamirpur DH588 District Women Hospital
D511 Hamirpur DH589 District Men Hospital
D512 Hardoi DH590 District Women Hospital
D512 Hardoi DH591 District Male Hospita
D513 Hathras DH592 Bagala Joint District Hospital, Hathras
D513 Hathras DH593 District Female Hospital Hathras
D514 Jalaun DH594 District Women Hospital
D514 Jalaun DH595 District Hospital
D515 Jaunpur DH596 District Femail Hospital
D515 Jaunpur DH597 District Male Hospital
D516 Jhansi DH598 District Women Hospital
D516 Jhansi DH599 District Hospital
D517 Jyotiba Phule Nagar DH600 Amroha
D518 Kannauj DH601 Combined District Hospital Kannauj
D519 Kanpur Dehat DH602 District Combined Hospital
D520 Kanpur Nagar DH603 UHM Male Hospital
D520 Kanpur Nagar DH604 Kpm Hospital Kanpur Nagar
D520 Kanpur Nagar DH605 Manyawar Kashiram Hospital
D520 Kanpur Nagar DH606 Distric Women Hospital
D521 Kashi Ram Nagar DH607 WH
D522 Kaushambi DH608 District Combined Hospital
D523 Kushinagar DH609 District Combined Hospital Kushinagar
D524 Lakhimpur Kheri DH610 DFH
D524 Lakhimpur Kheri DH611 DH
D525 Lalitpur DH612 District Female Hospital
D525 Lalitpur DH613 District Male Hospital
D526 Lucknow DH614 Shyama Prasad Mukherjee
D526 Lucknow DH615 Balrampur Hospital Lucknow
D526 Lucknow DH616 Awanti Bai Mahila Hospitals
D526 Lucknow DH617 Ram Manohar Lohiya
D526 Lucknow DH618 Rani Laxmi Bai Combined Hospital
D526 Lucknow DH619 Lokbandhu Raj Narain
D526 Lucknow DH620 Jhalkari Bai Mahila Hospitals
D526 Lucknow DH621 RSM Combined Hospital

Annexures
District
Code
D526 Lucknow DH622 Bhau Rao Devras Hospital Mahanagar
D527 Maharajganj DH623 District Combined Hospital
D528 Mahoba DH624 DWH Mahoba
D528 Mahoba DH625 DH Mahoba
D529 Mainpuri DH626 District Female Hospital
D529 Mainpuri DH627 District Male Hospital
D530 Mathura DH628 District Women Hospital
D530 Mathura DH629 District Combined Hospital
D530 Mathura DH630 District Male Hospital
D531 Maunathbhanjan DH631 District Women Hospital
D531 Maunathbhanjan DH632 District Hospital
D532 Meerut DH633 District Women Hospital
D532 Meerut DH634 P.L. Sharma Hospital
D533 Mirzapur DH635 DistrictWoman Hospital Mzp
D533 Mirzapur DH636 District Hospital Mirzapur
D534 Moradabad DH637 Male District Hospital
D534 Moradabad DH638 Female District Hospital
D535 Muzaffarnagar DH639 Female District Hospital Muzaffar Nagar
Swami Kalyan Dev District Hospital Muzaffar
D535 Muzaffarnagar DH640
Nagar
D536 Pilibhit DH641 District Male Hospital
D536 Pilibhit DH642 District Women Hospital
D537 Pratapgarh DH643 District Women Hospital
D537 Pratapgarh DH644 District Male Hospital
D538 Prayagraj DH525 Moti Lal Nehru District Hospital
D538 Prayagraj DH526 District Women Hospital
D538 Prayagraj DH527 Tej Bahadur Sapru Hospital
D539 Rae Bareli DH645 District Female Hospital
D539 Rae Bareli DH646 District Hospital
D540 Rampur DH647 District Male Hospital
D540 Rampur DH648 District Woman Hospital
D541 Saharanpur DH649 District Women Hospital
D541 Saharanpur DH650 SBD District Hospital
D542 Sambhal DH651 District Combined Hospital
D543 Sant Kabir Nagar DH652 District Combined Hospital Sant Kabir Nagar
D544 Sant Ravidas Nagar DH653 Maharaja Chet Singh District Hospital
D544 Sant Ravidas Nagar DH654 Maharaja Balavant Singh Distric Hospital
D545 Shahjahanpur DH655 District Women Hospital
D545 Shahjahanpur DH656 District Male Hospital

Annexures
District
Code
D546 Shrawasti DH657 Combined District Hospital
D547 Siddharth Nagar DH658 District Combined Hospital
D548 Sitapur DH659 District Women Hospital
D548 Sitapur DH660 District Hospital Male Sitapur
D549 Sonbhadra DH661 District Combined Hospital Robertsganj
D550 Sultanpur DH662 District Women Hospital
D550 Sultanpur DH663 District Hospital
D551 Unnav DH664 Uma Shankar Female Hospital
D551 Unnav DH665 Uma Shanker Male Hospital
D552 Varanasi DH666 District Women Hospital Varanasi
D552 Varanasi DH667 Pt. Deen Dayal Upadhyay Govt Hospital
D552 Varanasi DH668 Lbs Ramnagar Hospital
D552 Varanasi DH669 S.S.P.G. Div. Dist. Hospital
Uttarakhand
D553 Almora DH670 Distt Female Hosptial
D553 Almora DH671 Distt Hosptial Almora
D554 Bageshwar DH672 Shyam Lal Shah DH
D555 Chamoli DH673 District Hospital
D556 Champawat DH674 DH Champawat
D557 Garhwal DH675 DH Pauri
D557 Garhwal DH676 DH Female Pauri
D558 Hardwar DH677 Cr Women Govt Hospital
D558 Hardwar DH678 Hmg Hospital Hardwar
D559 Nainital DH679 B.D.Pandey Male Hospital
D559 Nainital DH680 B.D.Pandey Female Hospital
D560 Pithoragarh DH681 H G Pant District Female Hospital
D560 Pithoragarh DH682 B D Pandey District Male Hospital
D561 Rudraprayag DH683 District Hospital Rudraprayag
D562 Tehri Garhwal DH684 DH Bauradi
D563 Udham Singh Nagar DH685 J.L.N. District Hospital
D564 Uttarkashi DH686 District Hospital
D564 Uttarkashi DH687 District Female Hospital
West Bengal
D565 Alipurduar DH688 Alipurduar District Hospital
D566 Birbhum DH689 Rampuhat DH & SSH
D567 Dakshin Dinajpur DH690 Balurghat DH & SSH
D568 Darjiling DH691 Siliguri DH
D568 Darjiling DH692 Darjeeling DH
D569 Howrah DH693 Howrah District Hospital

Annexures
District
Code
D570 Hugli DH694 Imambara District Hospital
D571 Jalpaiguri DH695 Jalpaiguri DH & SSH
D572 Jhargram DH696 Jhargram DH & SSH
D573 Koch Bihar DH697 Mjn District Hospital
D574 Nadia DH698 District Hospital Nadia
D575 North Twenty Four Parganas DH699 Barasat DH
D575 North Twenty Four Parganas DH700 Basirhat DH & SSH
D576 Paschim Barddhaman DH701 Asansol DH & SSH
D577 Purba Medinipur DH702 Tamluk District Hospital
D577 Purba Medinipur DH703 Nandigram DH & SSH
D578 Puruliya DH704 D.M.Sadar DH & SSH
D579 South Twenty Four Parganas DH705 M. R. Bangur DH & SSH
D579 South Twenty Four Parganas DH706 Diamond Harbour DH & SSH
D580 Uttar Dinajpur DH707 Raiganj DH & SSH

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BEST PRACTICES IN THE PERFORMANCE OF

Copyright@ NITI Aayog, 2021

Report and Cover Design by YAAP

Available at: https://www.niti.gov.in/verticals/health-and-family-

Message from the

Best Practices in the Performance of iii

Best Practices in the Performance of v

vi Best Practices in the Performance of

Best Practices in the Performance of vii

viii Best Practices in the Performance of

Message from the Chief Executive Officer iii

1. Introduction to District Hospitals: The Centrepiece of the Health Care Delivery

2. Rationale and Approach for the Performance Assessment of District Hospitals............9

Best Practices in the Performance of ix

3.3 Availability of support services 34

4. Challenges and Limitations.......................................................................................................72

5. Learnings and Way Forward.....................................................................................................75

x Best Practices in the Performance of

Best Practices in the Performance of xi

xii Best Practices in the Performance of

ABARK Ayushman Bharat – Arogya Karnataka

Best Practices in the Performance of xiii

HIV Human Immunodeficiency Virus

xiv Best Practices in the Performance of

NMR Neonatal Mortality Rate

Best Practices in the Performance of xv

Best Practices in the Performance of xvii

xviii Best Practices in the Performance of

Best Practices in the Performance of xix

xx Best Practices in the Performance of

1.1 PUBLIC HEALTH CARE IN INDIA

PRIMARY SECONDARY TERTIARY

Specialists (gynaecologists, Specialised medical personnel

Figure 1: India’s three-tiered public health system

2 Best Practices in the Performance of

Table 1: Distribution of hospital services accessed in India

1.2 TOWARDS IMPROVED HEALTH OUTCOMES — SDGS AND

Best Practices in the Performance of 3

1.3 ROLE AND IMPORTANCE OF DISTRICT HOSPITALS

4 Best Practices in the Performance of

Key elements governing the functioning of district hospitals:

Affordability. Provide effective, affordable health care services (curative including

6 As on 31st March 2020, Rural Health Statistics, 2019–20.

Best Practices in the Performance of 5

1.4 ROLE OF A ROBUST HEALTH MANAGEMENT INFORMATION

HMIS captures facility-wise information on formats framed in close consultation with

Uploading facility-wise data on the HMIS web portal:

6 Best Practices in the Performance of

1.5 GLOBAL PRACTICES IN HOSPITAL PERFORMANCE

Best Practices in the Performance of 7

8 Best Practices in the Performance of

2.2 OBJECTIVES OF THE PROJECT

10 Best Practices in the Performance of

2.3 MEASURES USED IN THE ASSESSMENT

Table 2: List of Key Performance Indicators (KPIs) to assess district

Domain Category* Key Performance Indicator

A 1. Number of functional hospital beds per 100,000 population

2. a. Ratio of doctors in position to IPHS norm;

Structure c. Ratio of paramedical staff in position to IPHS norm

1.2 TOWARDS IMPROVED HEALTH OUTCOMES — SDGS AND

1.4 ROLE OF A ROBUST HEALTH MANAGEMENT INFORMATION

1.5 GLOBAL PRACTICES IN HOSPITAL PERFORMANCE

—Director of Health Services