How PSUs are building competence in healthcare facilities
For years together, the 300-plus PSU hospitals under the central and state governments have upheld a culture of comprehensive healthcare services to their employees and dependants. Most PSU hospitals run by Miniratna, Maharatna and Navaratna companies contribute immensely towards patient services. Right from ensuring hygiene and transparency, and averting unnecessary queues, PSU-run hospitals have been synonymous to better patient outcomes.
Number of Companies for which CSR Data is available
PSU organisations established with the objective of profit making in certain specified government sectors have been contributing immensely to healthcare via PSU hospitals by not only catering to the healthcare needs of their employees, contract workers and their families, but also offering services to people from in and around the cities, towns, village they operate. They are also known for effectively handle emergency cases like accident victims and heart patients.
As per the latest data compiled by the government, the total corporate social responsibility (CSR) spending has increased by around 11.6 per cent in 2015-16 compared to 2014-15. The CSR spending by PSUs has substantially increased in 2015-16 as compared to 2014-15. From Rs 2,497 crore in 2014-15, the spending has gone up to Rs 3,360 crore in 2015-16, an increase of 35 per cent. This follows adverse comments by the parliamentary standing committee on the CSR spending of PSUs. On the other hand, the spending by private companies has increased only marginally from Rs 6306 crore in 2014-15 to Rs 6462 crore in 2015-16.
“PSU hospitals get full funding from the PSUs and the grant they receive depends on the profit and other policy decisions. In some sense the PSU hospitals are part of their CSR activities,” informs Professor M Mariappan, Tata Institute of Social Sciences (TISS). Further, these hospitals are mainly focussed on their employees, so as to ensure the employee health which is directly associated with the productivity of PSU. Their overall administration, patient care and other important concerns are slightly better than the government hospitals. The government hospitals basically run as per the budget allocation of state or central governments. Usually they do not receive funds timely. As a result, the fund management or carrying out activities as per their plans may be difficult. In contrast, he points out that the private hospitals are able to serve with quality healthcare. However, they are costly for a large number of patients in the country. Unlike both a typical government and private healthcare facilities, PSU hospitals have some attachment towards their patients, because most of the patients are their employees. Employees are regular and stable workers. The relationship between the staff (patients) and doctors and nurses are relatively long lasting. Since the hospital is closely connected with the PSU, there are possibilities to provide better organised services.
Among the various activities for which CSR funds are allocated, education, health and WASH (Water, Sanitation & Hygiene) are the sectors in which most funds are spent. The healthcare and WASH sector has seen almost six per cent increase in the CSR spending in 2015-16. In healthcare, most PSUs concentrate on child mortality and maternal health, while MCA had data of 226 PSUs in 2014-15. It had the data of only 172 PSUs till date for 2015-16.
The hospital’s cultural climate is critical to the success of quality improvement programme, PSU-run hospitals have exceptional work culture, informs Shankar Narang, COO, Paras Hospitals, a multi-super specialty hospital, which has more than 35 PSUs empanelled to it.
“PSUs have the power to lead and invent exceptional processes to ensure that their employees are provided seamless healthcare services. The work culture in a PSU hospital is definitely good. They have exceptional numbers for primary care. They have a rich team of general physicians and doctors providing basic healthcare services,” Narang added.
Providing comprehensive care
Apart from providing emergency services and routine medical care for employees, PSU hospitals have dispensaries in their residential colonies, family welfare centres with a team of general practitioners and specialists.
Acknowledging the fact that ensuring good health of employees, their families and people residing in the surrounding areas of its plants and units is not just a matter of corporate responsibility, but a pre-requisite for sustainable all-round development, an official from Steel Authority India Limited (SAIL) said, “Over the years, SAIL has established 54 primary health centres (PHCs), 12 reproductive and child health (RCH) centres, 17 hospitals and seven super-speciality hospitals to provide modern healthcare to more than 30.60 million people. The hospitals have a total strength of around 4043 beds for the benefit of its employees, their dependants and the peripheral population and are managed by around 4000 trained medical staff. SAIL hospitals also implement the government’s RCH programme across all its plants and units.”
He also added that villagers with major ailments are referred by the health centres to the main plant or government hospitals for treatment, while minor operations are carried out in the centres.
Highlighting the health initiatives carried out by National Thermal Power Corporation (NTPC), the largest power utility maharatna company, an official said that they are specifically working on tuberculosis and NTPC has partnered with the Government of India on Revised National Tuberculosis Control Programme (RNTCP).
“Modern anti-TB treatment can virtually cure all patients, provided the treatment is taken for the prescribed duration, without interruption. Because of the long duration of treatment, patients who begin to feel better soon after the treatment starts, discontinue it, due to problems such as poverty and unemployment,resulting in fatality or development of multi-drug-resistant TB (MDR-TB). Thus, NTPC wants to help patients diagnosed with TB and we want them to be treated effectively till cure, by ensuring availability of the full course of drugs and a system for monitoring patient compliance to the treatment. Under CSR, NTPC provides a room for the consulting doctors, a small laboratory with microscope. An ambulance with paramedical staff, driver and PA system is provided which moves around the villages: creating awareness about TB, collecting and checking sputum samples, registering positive cases, collecting medicines from government centres and administering medicine to the TB patient under direct observation for the required duration. So every TB patient residing in the vicinity of 25-30 km of a station is brought under the TB Control Program. We ensure full course of drugs and patient compliance to treatment and we operate Directly Observable Treatment cum Designated Microscopy Centres (DOT cum DMC),” the NTPC official informed.
Apart from the TB programme, NTPC also provides need-based infrastructural support for healthcare like construction of PHCs, additional wards, ICUs etc. NTPC is also supporting the development of King George Hospital, Visakhapatnam.
Mobile Medical Units (MMU) is one of the healthcare initiatives which is carried out by most PSUs.The Indian Oil Board has accorded approval for Indian Oil Aarogyam scheme which will be launched in three Indian Oil refineries i.e. Mathura, Paradip and Bongaigaon on a pilot basis.
Indian Oil Corporation – Regular CSR activities under healthcare by various refinery units
NTPC – Healthcare initiatives via CSR
Stress on preventive measures and inculcate healthy lifestyles:
“Forty eight villages located within a 50-km radius of the refineries are being identified based on approved criteria. Four MMUs with medical staff will visit these specified villages and treat around 2080 patients per month, i.e. 24960 patients in a year. One refinery unit with four MMUs will treat approximately 1 lakh patients per year. Tentative date of launch is around August 2017,” said Kali Krishna M, Chief General Manager, Corporate Communication, Indian Oil Corporation.
Many PSU hospitals under the CSR initiative are trying to provide organised, referral-based system for secondary care. NTPC, Indian Oil Corporation (IOC), Gas (India) Limited (GAIL), Oil and Natural Gas Corporation Limited (ONGC), Neyveli Lignite Corporation (NLC) and many other PSU hospitals provide quality healthcare to the people living in the surrounding villages.
Reaching out to the unreached
The PSUs have taken initiatives to improve healthcare facilities in North East areas and Uttar Pradesh, as majority of the patients move out of the state for speciality treatment.
“IOCL’s Assam Oil Division (AOD) hospital was established as Digboi Hospital in 1906. The hospital was declared under the CSR activity for better healthcare system, preventive and public health services were initiated. It is a modernised 200-bed hospital which caters to the population of areas in the North East. General and specialised health camps are also organised regularly by the hospital to reach out to the poor villagers nearby, who have no access to medical facilities. Last year alone, 16,423 non-employee patients were treated at the hospital. The services available in the hospital are free of cost for the IOC employees and their dependants comprising parents, spouse and two children, who are recognised as Entitled Patient (EP). IOC also renders services for the community at large scale with nominal charges, recognised as Non Entitled Patient (NEP),” Krishna says.
According to the Krishna, the same hospital runs Sarve Santu Niramaya (SSN), a CSR project since 2012 to provide free health consultation and medicines to both human and livestock population of Digboi and nearby areas. The Chikitsa Seva Kendra, BGR, Assam was set up in 1996 at Kukurmari (Bongaigaon) with paramedical staff, OPD services and free consultation.
“On an average 30-40 patients visit the centre every day. It is beneficial for marginalised people residing in the neighbouring areas. More than 35,000 locals have benefited out of this initiative,” Krishna added.
Percentage of funds spent on various CSR activities
Listing out the details of the IOC healthcare initiatives, the official further said, “The other well-known hospital of IOC is Swarna Jayanti Samudayik Hospital, Mathura, Uttar Pradesh. This 50-bed hospital provides medical assistance to residents near Mathura Refinery, Uttar Pradesh. Two mobile dispensaries travel to nearby villages to provide free medical care to the villagers. The hospital provides free treatment to the destitutes and offers subsidised treatment to others. During 2015-16, 52,660 patients were treated, and so far about eight lakh patients have benefited from this project.”
ONGC, one of the biggest PSU spenders, has signed a Memorandum of Agreement (MoA) for setting up a multi-speciality hospitality in Assam. The PSU signed the MoA with Aurangabad-based Dr Babasaheb Ambedkar Vaidyakiya Pratisthan (BAVP) to set up the Rs 312.34 crore hospital at Rajabari in Sibsagar district, which would be completed in three phases.
An ONGC official informed that ONGC is committed to implement its CSR initiatives across the country and has given special focus on the North East by setting up its single largest project anywhere in the country.
Many patients requiring secondary healthcare are referred to these PSU hospitals. At many locations, these are the only hospitals available, providing the required secondary care to the surrounding villages.
Rapport with private hospitals
PSUs are organisations that are looking for exceptional care, personalised services and attention. Just like numerous government employees, they have health coverage through various instruments to provide medical benefits. Majority of PSUs provide full coverage to their employees for treatment. They individually associate with the hospitals through an MoU and may or may not follow a set pattern of tariff.
Informing that PSUs have in-built systems to ensure that the employees opt for the right doctor, hospital and specialisation, Narang of Paras Hospitals explains, “They have an in-house medical team that scans their medical issues to recommend hospitals. They also provide the patients an authorisation letter to ensure that the patients have been authorised and cleared with approvals for the treatment. This also assures the hospital that the bills shall be duly approved by the PSU and also creates a feedback and monitoring mechanism that benefits the patient. In case of emergency conditions, the hospital and the medical arm of the PSU coordinates to ensure that the patient doesn’t suffer. Treatment is provided and letters are given later.Hospitals understand the strength of the PSUs and the employee numbers, hence service delivery, efficiency along with transparency and good follow up become pivotal along with relationships. We are the preferred providers for neurosurgery, neurology, cardiology, cardiac surgery and orthopaedics and joint replacement. At Paras Patna, we are also the preferred providers for cancer and nephrology.”
He also added that Paras gives PSU employees a number of benefits like cashless facility, much discounted rates than the other general self paying patients, assistance in facilitation of medical services, free or discounted rates for emergency facility like ambulance and organising free medical check-ups and talks by seniors or HODs.
However, there are a number of challenges that PSU employees face while seeking or searching for medical care. Many employees are not aware which private hospitals they are empanelled.
“Numerous patients are looking for specialised care and are not able to know the hospitals that provide cashless facility. This limits their choice or inherently makes them totally dependent on the in-house medical team for directions. We believe that a patient from a PSU is a person who should be aware of all options and then choose as per their will and conditions. Hence to bridge the gap of creating education, Paras Hospital has started numerous patient reach campaigns such as highlighting and promoting our presence on social media channels such as Facebook and Twitter. Northern Railways was particularly benefited through this campaign and the response has been quite positive. Many PSU employees are not aware about the steps of availing medical benefits. We have formulated a standard procedure of explaining to the patient and their attendants the same. We also provide them the contact numbers and details of their medical arm that can facilitate them in the approvals and the decision making,” Narang added.
At present, PSU hospitals refer patients to private sector hospitals for higher-level of treatment. The major issue likely to arise between PSU and private sector is that the private sector usually expects a profit where a PSU does not have a profit motive. The work culture to a large extent is process-oriented. Private hospitals have the limitation of providing services which could be loss making if they are long-term in nature. It must be a two-way exchange of information and returning patients to those who referred them for follow up care.
Though PSUs have the power to lead and invent exceptional processes to ensure that their employees are provided seamless healthcare services, it is essential that they come together and work at a better framework that can address all their gaps.
Filling the gaps
According to experts, a concerted effort by the central and the state governments is necessary so that the initiatives made by PSUs in healthcare could be channelised. They have sufficient scale and connectivity, so if one could work with them to understand their perspective and try to put a framework in place, healthcare issues could be sorted out in a more systematic and cost-effective manner. For example, two or three PSUs and private healthcare facility existing in a common area with the available resources can jointly run disease control programmes and family welfare programmes with the help of the state and central government. Thus it will help in optimum utilisation of the existing resources.
“It is good to develop a partnership with all kinds of hospitals, particularly the government hospitals. It is understood that the care provisions, practices, methods and kind of patients of PSUs are much different from that of government hospitals. The objective, nature of functions, kind of patients vary between PSUs, government and private run hospitals. Further, the nature of funding makes a huge difference. In India, the healthcare sector is too diverse which caters to different kinds of population. If the three segments — PSUs, state and the central government — align together, they can transform and bring in a new paradigm in healthcare services,” added Mariappan.