Governance

How Rogi Kalyan Samitis play a role in ensuring self-reliant hospitals in India

The role of an RKS — or hospital management committee — to contribute to Aizawl civil hospital’s growth is worth noting

 
By Vishal Sah
Published: Friday 04 September 2020
Aizawl civil hospital was able to hire more manpower using their funds amid the novel coronavirus disease (COVID-19) pandemic. Photo: Twitter / Kannan Gopinathan / @naukarshah

Rogi Kalyan Samitis (RKS) — or hospital management committees — were introduced in 2005 under the National Rural Health Mission (NRHM) as a forum to improve the functioning and service provision of public health facilities, increase participation and enhance accountability.

The RKS has an executive committee and a general body that consist of elected representatives, the district administration and medical department representatives who discuss the long-term vision and regular affairs of the concerned hospital.

As a probationer undergoing district training in Mizoram’s Aizawl, I attended the executive meeting of an RKS at a civil hospital. The meeting was convened at a time when the call for Atmanirbhar Bharat (self-reliant India) was already given by Prime Minister Narendra Modi.

John Zohmingthanga, deputy medical superintendent of Aizawl’s civil hospital, said the civil hospital was already self-sufficient from external aid provided by state government’s health department, with it being possible because of a proficient RKS at their disposal.

The civil hospital at Aizawl began with a seed grant of Rs seven lakh in 2013, with a budget of Rs six crore now. They are entirely dependent on funds collected as user charges by the RKS to meet their annual revenue and capital expenditure. Hospitals often find it difficult to raise money while keeping public health services accessible and affordable to every citizen.

The civil hospital does not charge patients who are affected by the human immunodeficiency virus, tuberculosis and those under the below poverty line category, according to Zohmingthanga. Hospital employees and their families usually do not pay user charges either.

The treatment of patients with serious injuries from accidents under the Good Samaritan law passed by the Supreme Court was also managed through RKS funds.

Despite this, Aizawl civil hospital’s deliberative and consultative decision-making led to the framing of reasonable user charges and efficient collection for the formation of a large corpus of funds that were proactively used to augment facilities in the hospital, leading to further fund generation and ensuring fiscal strength.

The hospital was able to hire more manpower using their funds amid the novel coronavirus disease (COVID-19) pandemic. The management also ensured none of the 600 employees — or the roughly 1,000 people who visited the hospital every day — tested positive for SARS-CoV-2, the virus that causes COVID-19 inside their premises.

The hospital, thus, had no COVID-19 cases, according to the guidelines of the Union government.

While RKS can contribute to hospitals in becoming self-sufficient, there is still a long way to go. A diathermy instrument — used to stimulate heat in a part of the body by high-frequency electric currents — that was sanctioned for the hospital was imported from Germany.

This showed the state of medical instruments production in India, still behind in manufacturing such items. More medical equipment manufacturing clusters such as one announced in Tamil Nadu capital Chennai can be promoted.

The entire supply chain needs to be strengthened and youth must be skilled in this direction. To decrease our import dependence, we need to start more active pharmaceutical ingredient manufacturing clusters.

The race to introduce a vaccine against COVID-19 in the market also points out bottlenecks existing in the patent and clinical trial system that need to be resolved.

With the Ayushman Bharat scheme, hospitals are relatively at liberty to charge fees, as the insurance companies are to make the payment. There is a need to rationalise hospital fees to current times, while keeping specific exemptions for non-Ayushman cases in mind.

As the budget of RKSs run into crores, there is a need to bring in professionalism to the financial management, supply chain management and equipment management.

RKSs must be revamped using artificial intelligence and machine learning to undertake steps. These must include forecasting patient load, essential medicines and equipment procurement plans, a long-term perspective plan and an annual plan to create capital assets and marketing of services offered for a greater footfall.

Membership of RKSs can be made from a pool of eligible prospects of sound knowledge and prior experience. The NRHM was consistent in creating a roadmap for benefiting local communities and their participation through the RKS, which carries the potential to make self-sufficient hospitals a reality.

There must be a good start, as we still have a long way to go.

Views expressed are the author’s own and don’t necessarily reflect those of  Down To Earth.

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