Rebuilding trust

201702ehm02A quick read through the year end review of the initiatives and achievements of the Ministry of Health and Family Welfare is impressive. In fact, Union Health Minister JP Nadda has gone on record to say “that the past two years have witnessed a historic growth in the form of infrastructure and other facilities.”

He was speaking on the day India’s premier public health institution, the All India Institute of Medical Sciences (AIIMS), New Delhi,  signed three MoUs of a cumulative net worth of Rs 7670 crores,  which the Health Minister pointed out was the the largest ever health sector investment commitment made by the Government in a public health project at one event. His assertion that all new AIIMS will be “AIIMS” and not “AIIMS-like” is also very promising, because AIIMS-Delhi is definitely a centre of excellence but it is forced to cater to patients far beyond its capacity, due to the dearth of similar facilities in other states.

It will be quite a few years before the new AIIMS (spread across the country in Bhopal, Bhubaneswar, Jodhpur, Patna, Raipur, Rishikesh, Raebareli (Uttar Pradesh), Nagpur (Maharashtra), Mangalagiri (Andhra Pradesh), Kalyani (Bengal) become fully operational and acquire the reputation of AIIMS Delhi, but at least a start has been made.

A significant aspect of the MoH&FW’s achievements is that it has chosen to invest time and efforts to tighten the infrastructure at existing public health facilities as well. And this initiative has already reaped rewards. A few significant early wins could push other laggards to move faster.

Last year, under the Biomedical Equipment Management and Maintenance Programme (BMMP), the Ministry set out to first map the inventory of all bio-medical equipment with the key aim of gauging their functionality.

The mapping was successfully completed in 29 states, covering more than seven lakh pieces of equipment, worth around Rs 4564 crores, in over 29,000 health facilities.

Results from the 29 states where the mapping was completed were discouraging. 13 per cent to 34 per cent of equipment was found to be dysfunctional. The cost of this dysfunctional equipment was estimated at a whopping Rs 1015 crores. Which meant that about a fourth of the equipment was not available for public use, simply because the authorities had not got it fixed, for a variety of reasons.

The Ministry then prepared comprehensive guidelines and supported these states to redress the sorry situation, primarily by rolling out a tender process to outsource the maintenance of existing medical equipment.

Eleven out of the 29 states mapped out,  (Andhra Pradesh, Kerala, Rajasthan, Mizoram, Chandigarh, Maharashtra, Sikkim, Madhya Pradesh, Punjab, Jharkhand and Puducherry) have now successfully outsourced equipment maintenance while three states (Tripura, Nagaland, and Arunachal Pradesh) have completed the tendering process and are reportedly at the implementation stage.

Five states (Uttar Pradesh, West Bengal, Chhattisgarh, Karnataka, and Gujarat) are in the process of finalising tenders, while the remaining ten states are yet to get off the block.

The 12 states where work orders have been already been issued have already seen promising results: dysfunctional equipment costing Rs 378.11 crores became functional four months from the time the work order was passed. Even better, there has been a reduction in the equipment break down rate by about 25 per cent. Downtime of three to four months has reduced to maximum downtime of seven days, which means that equipment is being repaired faster.

While the new AIIMS might seem like a distant vision, closer monitoring and sprucing up of existing  infrastructure will go a long way towards rebuilding trust in India’s public health facilities. We hope to discuss and deliberate on more such policy initiatives at Healthcare Sabha, from February 9-12. We’ll be back with key takeways from the conference in our March edition.

Viveka Roychowdhury