Imagine a government hospital to which patients from
private hospitals are shifting. That's just what Maharaja Yashwantrao Hospital
in Indore is all about. Patients like Dev Narayan Goyal who have shifted
to this hospital after a fairly long stay in a private nursing home is no
exception. "Here", he says, "not only is the treatment good
but also cheap. Patients no matter how poor are not turned back. Instead
their treatment is supported by adequate donation that the hospital
Clean and well run.
MY Hospital is not just a good hospital. It is also the
first government specialty hospital in the state that is generating its own money when the funding by the state is no longer possible. And it
would perhaps be the first hospital in India where the idea of people's
participation was successfully implemented. At a time when most of the
government hospitals in the country are cutting down on even basic
facilities for the poor hapless patients, MY Hospital actually took a big
leap in the newer areas of medicine and surgery and bought latest
equipments through its own resources. This it did by raising money on its own through the introduction of user charges that were kept very low
keeping its basic objective to serve the poor in view, and through a
motivational campaign amongst the city dwellers that brought in more and
more money via personal and corporate donations.
As I walked in the huge corridors of the seven storied MY
Hospital I found that its lift dating back to the fifties actually
worked. At the main entrance where new patients register themselves, a
neat and clean stall with a spick and span dustbin, sold coffee through a
vending machine; an unusual sight in any government general hospital
anywhere in our land. It struck me that MY Hospital would perhaps be the
best government hospital in the country. Shouldn't this be replicated
elsewhere? Isn't this what the welfare state should engage in?
But the road to this has not been easy.
Indore was once the centre of health care in western
India. India's first medical institution, King Edward Medical School was
established here as early as 1848. When Maharaja Yashwantrao Hospital,
named after the last Holkar ruler was inaugurated in 1955, it was Asia's
largest government hospital. But over the years decadence had set in, not
only in terms of infrastructure but even financially.
An enormous task of cleaning up the mammoth MY Hospital,
which during its peak hours has more than five thousand people in its premises, was taken up. Under this operation Kayakalp, the entire hospital
was stripped bare. Patients already admitted in the hospital were not
discharged at random. Rather they were shifted to 12 other hospitals in
town. In the cleaning process that ensued, thousands of rodents which had
mad MY Hospital their abode were gassed and killed. About one hundred and
fifty truckloads of garbage and junk were removed from the hospital.
Public gets in.
It was during the course of this cleaning up operation
that the district administration under the then collector, Mr. S R Mohanty
had the first taste of public participation. When the administration
appealed to people for money for the cleaning up process, donations poured
in. in the first week of Operation Kayakalp itself more than Rs.10 lakhs
was collected through donations. The members of the Indore press also
contributed Rs.8 lakhs. to maintain people's participation and as a kind
of social audit, the clean up operation was done through the District Red
But now that the hospital was cleaned up, a question
emerged on how to maintain the tempo. the state government under whose
purview the subject of health falls, had no money. MY Hospital had only a
bare infrastructure, insufficient even for basic health care needs. No
funds were forthcoming. The coffers of the state were empty. If left to
itself, the hospital would have reverted to its old ways. a novel
approach was desperately required. It was then that the idea of Rogi Kayan
Samiti [RKS] in which people's participation is a key element, emerged.
To ensure greater people's participation, the Rogi Kalyan
Samiti comprised of a cross section of the district's society. The dean of
MGM Medical College under whose jurisdiction the MY Hospital falls, the
Medical Superintendent, Heads of department, the District Collector, the
revenue Commissioner, the regional Director of Health, MPs and MLAs,
president of the Zilla Parishad, representatives of important business
houses, the district Red Cross Society, and NGOs are its members. The
Minister in charge Indore heads RKS.
The concept of user charges was not a new idea. It was
levied in Indore for the first time at Chacha Nehru Children's Hospital
and research Centre way back in 1985. Mr. Vijay Singh who was the Revenue
Commissioner of Indore then, had mooted this idea. What RKS at MY Hospital
did was to streamline the process, thereby giving it a coherent shape. As
Dr. D K Taneja the Dean of MGM Medical College says, "One doesn't
mind paying two rupees for a platform ticket so why shouldn't pay for the
services of MY Hospital?" The amount was kept at a bare minimum. It
started with two rupees for the OPD ticket, which now costs Rs.5/-. Even
the specialised services of the ICCU are charged as low as Rs.150 per bed.
At the same time broad guide lines were drawn up for the
levy of user charges. According to the guidelines, all facilities of the
hospital were to be charged, but persons below the poverty line are
totally exempt from any payment. For this a mere declaration by the
patient is accepted rather than going through a labyrinth of paper work.
All funds received through the levy of user charges are deposited with the
RKS. Donations from people too constitute an important component of the
hospital's earnings. The monthly collection through user charges come to
around Rs.6 lakhs, when earlier it was nil.
This money is then allocated to different departments for
their day to day needs. it helps them to take their decisions
independently, instead of waiting for the release of funds from the
The pride amongst the doctors and staff members for their
hospital quite palpable. They are motivated enough to set aside something
for their hospital. For example, Roop Singh Karode, an accountant with MY
Hospital has donated marble benches for the patients to sit on in the orthopedics
department. Sister G.Ruben with the trauma centre has donated the opaque
glass on the swiveling door of her centre. there are cases when three men,
who could not donate a fan individually, pooled their resources together
to buy a fan for the hospital. One such fan is in the orthopedics ward.
The names of the donors are written, one on each blade. The result of all
these efforts has been to vastly improve the quality of services. The
diagnostic facility that includes the latest machinery actually works.
Advanced surgery like joint replacement surgery with imported joints is
now within reach of almost all. A surgery that in a private hospital would
cost around Rs.100,000, costs only Rs.13,000 in MY Hospital, part of
which, if the patient is poor is funded by the Rogi Kalyan Samiti and the
Ranavat Foundation. As mentioned earlier, patients like Dev Narayan Goyal
have also begun shifting from private nursing homes to MY Hospital. Says
Shanti Bai, a poor old woman, "even if you pay Rs.50 per day per bed,
it is still cheap." Shanti Bai is quite satisfied by the services
that the hospital offers and reserves her special praise for the young
doctors who she feels are taking good care of her.
The idea spreads.
The experiment of Rogi Kalyan Samiti, in Maharaja
Yashwantrao hospital was such a great success that Mr. Digvijay Singh, the
Chief minister of Madhya Pradesh has adopted it as his state policy. As a
result, similar Rogi Kalyan Samitis have been set up in over 2000
allopathic hospitals and dispensaries, 197 Community Health Centres and in
most of the 1690 Primary Health Centres throughout the state in the last
year. Total monthly collection in the state through user charges is now
estimated at Rs.50 lakhs. So far a total of over Rs.18.50 crores have been
collected through donations and user charges.
The best results have been changes in the mental make-up
of the beneficiaries. Since now they pay for the services, it is not an
unusual sight to see them demanding attention.
Published by kind courtesy of 'Grassroots'
"As I walked in
the huge corridors of the seven storied MY Hospital, I found that it's
lift dating back to the fifties actually worked"
years on, the dean Dr.Taneja is confident the new culture has taken hold.
can see the spotlessly clean lobby and environs. Marvel at the calm air,
devoid of the noise and clamour of an Indian hospital.
with the most liberal enforcement, collections are up! Several capital
intensive equipments like x-ray machines, image intensifiers and dialysis
machines have been acquired from the hospital's own funds. Services like
security, toilet upkeep have been privatised.
the idea of Rogi Kalyan Samiti [RKS] has taken off.
Hindustan Times on Oct.3,2000 reported that, in 3 years RKS has spread to
450 hospitals across MP; Rs.37 crores have been collected as user
fees, from a willing public. "At a small place like Seoni, an
Intensive Care Unit could be established at cost of Rs.70lakhs because of
the money collected in the account of RKS there."
one hundred and fifty truckloads of garbage and junk were removed from the