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A govt. hospital of the people, for the people 

Anand Jha narrates the Indore example in public health !

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 manages."

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.

Holkar's vision.

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 Cross Society.

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.

Usage fees.

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.

Proud staff.

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 finance department.

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' magazine

"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"

Update: October,2000


Five years on,  the dean Dr.Taneja is confident the new culture has taken hold.

You can see the spotlessly clean lobby and environs. Marvel at the calm air, devoid of  the noise and clamour of an Indian hospital.

Even, 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.

And the idea of Rogi Kalyan Samiti [RKS] has taken off.

The 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." 



"About one hundred and fifty truckloads of garbage and junk were removed from the hospital."