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OFFTRACK:
MADHYA
PRADESH
Off Oxygen
Citizens'
initiative puts a little life back into moribund hospitals
By Neeraj
Mishra
It
started with the rats. 1994, Indore. A plague scare had just broken out
in neighbouring Gujarat. The disease, it was said, was carried by rats.
The city's Maharaja Yashwant Rao Hospital was home to a few thousand of
these creatures. So utterly out of control was the situation there that
two people had already died of rat bites. The people of Indore were struck
by the belated realisation of a truth that had once come home to the people
of Hamelin: that something needed to be done, urgently.
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| Mohanty
has won the Global Development Award for his patient welfare scheme
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Perhaps in
another day and age he would have looked for a pied piper, but Indore's
District Magistrate Sudhir Ranjan Mohanty decided to do the trick the
traditional way. The 1,000-bed hospital, he decided, would have to be
vacated, cleaned up and refurbished-and the rats would be trapped and
killed. The catch: the treasury didn't have the money for this operation.
So Mohanty
decided to implement an obscure state government directive which allowed
the formation of Rogi Kalyan Samitis (RKS) or patients' welfare societies.
These societies could become involved with the running of public hospitals
by raising funds. When the idea went public, people responded with an
enthusiasm Mohanty had not anticipated. Within a month Rs 48 lakh had
come in, and the reign of the rats in Maharaja Yashwant Rao Hospital was
willy-nilly over. More than that, a movement had been born.
Mohanty
was in Tokyo recently to receive the first $1,25,000 (Rs 57 lakh) Global
Development Award instituted by the World Bank for the most innovative
development project. After a presentation before a jury that included
Nobel laureates Amartya Sen and Douglas North and World Bank President
James Wolfensohn, he was given the prize. The real worth of his work is
in the results. More than half of the nearly 1,200 public hospitals in
the state now have an RKS. An estimated Rs 37-40 crore has been raised
across undivided Madhya Pradesh in the past five years and spent on the
improvement of hospitals. A unicef assessment done in the past week found
that the involvement of people has changed the shape of the public health
delivery system to an extent where: "people are not dependent on
quacks ... the system actually works". In a country where few systems
work, that is high praise.
It was a
coming together of forces that made this miracle. After the hospital had
been cleaned and refurbished, everyone-donors, the press, the local MP,
staff union, doctors and patients-wanted to evolve a system for continued
upkeep. Chief Minister Digvijay Singh, who came to inaugurate the new-look
hospital, was impressed. He ordered the scheme's implementation all over
the state, says Mohanty. RKS groups were constituted with donors, leading
citizens, social organisations like Rotary Club and the Red Cross, district
administration and doctors as members who would control funds and decide
on improvements to be made. To this the Government added changes like
installing a cabinet minister at the head of every district RKS. It even
opened hospital land to commercial use to enable fund-raising.
Digvijay-for
whose Government this is the third such recognition after its education
guarantee scheme and Gyandoot intranet service won international awards-says,
"The RKS introduced two entirely new concepts in health governance.
First, we successfully experimented with user charges and have found that
people cooperate, and two, a process of self-certification for those below
the poverty line has found wide acceptability."
The system
still has some lacunae. Overall control of the local RKS bodies remains
in the hands of the collector and if he is not interested in healthcare
then the whole thing might just drift. Another issue is that all public
hospitals have huge lands and over the years their commercial value has
increased. With the Government allowing commercial use of hospital land,
the situation is ripe for a scam.
Mohanty
believes this won't happen: "Even a corrupt person does not find
it easy on his conscience to swindle hospital money," he says.
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