Brief review of organizational evolution of hospital and history of hospital evolution in Afghanistan.

1. HOSPITALS
&
HISTORY OF EVOLUTION OF
HOSPITALS
Hospital Management Training

2. Session Objectives
At the end of the training the participants will be able
to:
 Understand the history of evalution of hospitals
 Underatands the history evalutions of hospitals in
Afghanistan
 Discuss the future of hospitals
 Understand the definition of hospital
 Name different types of hospitals

3. History of Evolution of Hospitals
 Individual healer were visited by sick people or ill
persons (one to one situation of services provision)
 Temples/worship places for gods of health and sick
people visted or were left at these place to get well
(Egypt, Greece, India)
 In Christianity serving the less fortunate (poor, sick,
hungry, widows, children, strangers) is a centeral
theme so sick people wards became a part of the
Monasteries
 Fourteen century Germany established care
centers for Black Plague victims
 Centers were established outside cities for
contagious diseases such as Leprosy, TB

4. An old US Hospital

5. OT rooms of earlier hospitals

6. History of Evolutiuon of Hospitals
 Hospital were considered last resort for treatment
as hospital were center of mortality (early 1940s)
but after germ theory and antibiotics and
perception about hospitals have improved
 Now hospitals have become complex organization

7. A modern Hospital

8. History of Evolution of Hospitals
The evolution of hospitals in the Western world from charitable
guesthouses to centers of scientific excellence has been
has been influenced by a number of social and cultural
developments. These influences have included the changing
meanings of disease, economics, geographic location,

9. History of Hospital
(Afghanistan)
 Healing through prayers, ‫جادو‬ ‫و‬ ‫سحر‬
 With Alexander’s invasion, came the Greek Healers
(‫طبیبان‬ ‫یونانی‬ ) and diseases were treated by Greek
healers or local healers (‫حاذق‬ ‫)طبیب‬
 Hakeem Ji came from India and provided treatment
 After Islam: the Islamic ideas of personal hygiene,
ideas of Greek, Indian healing, and local
experiments of healing interacted and treatment
practices emerged (Ibn-i-Sina; Al-Shifa)
 First hospital was established in 1800s during reign
of Amir Abdul Rehman (Ibn-i-Sina Hospital)

10. Amir Sher Ali Khan Qala-e-Shir Pour
Hospital

11. Ambulance in Afghanistan
(1870s)

12. Question ??
 Do you know the history of your own hospital ?
 Which hospital are you working ?
 What first first version of the hospital (clinic, DH,
PH, and now) ?
 Do you have a written or documented history of
your hospital ?
 Is possible to create a wikipedia page about the
history of your hospital ?

13. Future of Hospitals
 Future of hospitals
 AI/Digitalization revulationizing care
 Robot surgeries, algorithims for interpretation of
imaging, digital medical doctors
 Care shifting back to homes

14. What is a hospital ?
 The word hospital is derived from two Latin words
 Hospes meaning “Guest”
 Hospitale meaing accommodations or lodging place
 An Institution that provides medical or Surgical
Care for the sick and injured (American Heritage
Dictionary)
 A Place Where peoples are treated for illness or
injuries (Oxford Dictionary)

15. What is a hospital ?
According to WHO :
Hospital is an integral part of a social and medical
organization. The funciton of which is to provide for
the population complete health care (both curative
and preventive)and whose out-patient services
reach out the family and its home enviroment.
The hospital is also a center for training of health
worker and for biosocial research. 1956 WHO
Expert Committee

16. Functions of a Hospital
Based on WHO definiton a hospital has the following
functions :
 Curative Services (OPD, IPD, Emeregency, …)
 Preventive Services (Health Education, Vaccine,
ANC, PNC, FP, Malnutrition Screening,
Rehabilitation services …)
 Training Services (formal & informal training)
 Research Services (social, behavioral, medical …)
 Outreach services (community surviellance, school
screeing services, medical camps ….)

17. Functions of a Hospital
(discussion)
What do you think, why are the below true for your
hospital ?
 OPD very very very crowded, why ?
 Receive near to death patients/critical patients
and then perform procedures on them, why ?
 Have cholera, measles out break in hospital
catchment area, have AWD ward in hospital,
why ?
 Do know what type of patients your hospital will
get in next 2-3 years ? Is your hospital ready for
the type of patients ?

18. Functions of a Hospital
 If you want to improve almost all the functions
of the hospital then as a hospital adminstrator
or hospital director/manager focus on :
 Improving hospital preventative services (what
are the hosptial preventative services ?)
 Strengthen or Establish effective outreach
services
 Luckily DH hospitals have established outreach
services but they are not fully utilized (what is
outreach services of DH?)
 There is a need to establish outreach services for
NRH and PHs

19. Functions of a hospital
 Can you give some ideas to establish outreach
programs for NRH or PHs ?
 How can the outreach program benefit us ?
 Establish surveillance in community (know about
what type of patients you will get)
 Decrease burden on hospital
 Get funding for out reach services (extra money)
 Improve Research
 Improve perception in community

20. Type of Hospitals
I. According to Public Access
1 Community Hospitals
2 Non Community Hospitals
II. According to Ownership
1 Federal Hospital
2 Provincial Hospital
3 N.G. Not for profit Hospital
4 Investors, Owned for profit Hospital

21. Type of Hospitals
III. According to length of stay
Short term stay less then 30 days
Long term stay more then 30 days
IV. According to Number of beds
06 – 24 beds
25 – 49 beds
50 – 99 beds
100 – 199 beds & so on

22. Type of Hospitals
V. According to Medical Education
-Teaching Hospital
-Non Teaching Hospital
VI. According to vertical integration
-Primary Care Hospitals
-Secondary Care Services
-Tertiary Care Services

23. Type of Hospitals
VII. According to Scope of Services
-General Hospitals
-Specialized Hospitals

24. Types of Hospitals
 Different of Public Hospitals in Afghanistan
 Speciality or referral Hospital (mainly in Kabul)
 Regional Hospital
 Provincial Hospital
 District Hospital
 What is wrong with the above classification ?
 How can we improve this ? (advocacy for a better
classification)

25. Thank you
 Any Questions ??