In India, where the government is still struggling to meet basic health care needs and many primary health care facilities border on the primitive, meeting this appeal appears ambitious. But given that the country has been besieged by national calamities and unforeseen emergencies such as 26/11, it is certainly the need of the hour. We get some prescriptions from industry experts.
Mandatory quality standards
Monika Sood, who heads the health care practice of New Delhi-based infrastructure consultancy firm Feedback Ventures, estimates that less than 10% of the country’s hospitals would be equipped to handle emergencies. Pervez Ahmed, CEO, Max Healthcare, who is also part of several CII (Confederation of Indian Industry) committees on health care, points out that less than a dozen hospitals in the country are accredited by the Joint Commission International or JCI (the international gold standard in quality norms for hospitals) and only 28 are accredited by NABH (National Accreditation Board for Hospitals and Healthcare Providers)—numbers far too low for comfort.
Illustration: Jayachandran / Mint
Since both JCI and NABH set exhaustive standards for hospitals and health care providers, patients can be assured of safety, hygiene, privacy, dignity and better clinical outcome at accredited hospitals. Such hospitals also have disaster preparedness manuals and practice drills.
Prescription: “Mandatory accreditation should be the single-point agenda for the sector if we are to give quality health care to India,” says Vishal Bali, the Bangalore-based CEO of Wockhardt Hospitals and another active CII member. He says the Gujarat government has been forward-looking in preparing all its state-run hospitals for NABH accreditation.
Sood says mandatory accreditation may not be practical or feasible for all our hospitals yet (many of them were set up about 50 years ago), but suggests that if corporate and insurance firms (and eventually, the Central Government Health Scheme, or CGHS) only empanel hospitals that are NABH-accredited, hospitals will have an incentive to upgrade.
Sood also suggests creating customer awareness about NABH accreditation (currently, patients choose a hospital because of a doctor they know rather than the hospital’s facilities or quality certificates).
Integrated emergency management network
In India, millions of deaths occur during emergencies because people don’t know who to call, or because calls couldn’t be attended to in time. The system of emergency response is fragmented, though talks have been on to designate 108 as the national trauma care number (for mobile phones and landlines alike).
It is already the emergency response number in several states, notably Andhra Pradesh and Gujarat (where fairly efficient emergency management models have emerged through a public-private partnership, or PPP).
In Mumbai and Kerala, viable private sector models, such as the 1298 service run by Ziqitza Healthcare, have emerged. In New Delhi, too, a PPP model is likely soon: Apollo and Max Hospitals have jointly pitched for this. “The hope is to see this in place before the Commonwealth Games,” says Dr Ahmed. There’s already the well-equipped new Jai Prakash Narayan Apex Trauma Center at AIIMS, a dedicated emergency hospital.
Prescription: Significant developments have taken place since the setting up of CATS (Centralized Accident Trauma Services) in the 1990s and EMRI (Emergency Management and Research Institute) in 2005. EMRI, which operates in the PPP mode, handles medical, police and fire emergencies through the 108 emergency service and has ambulance services across Andhra Pradesh, Gujarat, Uttarakhand, Goa, Chennai, Rajasthan,Karnataka, Assam and Meghalaya.
Most states are attempting to outsource emergency services. PPPs, everyone agrees, are the best way forward. However, progress has been slow because of litigation, red tapism and other factors. But ultimately, the state can only do so much.
Also, as Dr Ahmed says, emergencies can only be handled efficiently if citizens do their bit too. For instance, how many vehicles give way to an ambulance with sirens blaring in heavy traffic? “We probably need legislation whereby cars that don’t give way to ambulances are fined heavily,” he suggests.
Sood recommends that private sector companies train some of their personnel in emergency management procedures so that every workplace has a skilled volunteer.
National emergency medical council
At the national level, there is the National Disaster Management Framework which lays down guidelines for responding to emergencies and calamities. Most of the support (and the command centre) is obviously in the hand of the government which, through military or paramilitary forces, is better placed to respond to calamities that could occur in remote areas and may require rescue operations by air, boat and other resources. The private sector enters on a purely voluntary basis.
Prescription: There is scope for resources to be mobilized in a more coordinated, efficient manner so that those nearest at hand, whether a private or public concern, can be deployed immediately and duplication of efforts is avoided. Says Bali: “It is important that there...be a single body with representatives from both public and private institutions which works on creating a very effective national disaster management programme.”
For medical emergencies, he says, there are lessons to be learnt from other South-East Asian countries such as Singapore, which handled the severe acute respiratory syndrome (SARS) threat efficiently.
State emergency medical council
According to Dr Ahmed, the CII has been urging state governments to set up state emergency medical services councils to handle unexpected contingencies, and has even prepared a model (adapted from the California state emergency medical council). Gujarat is the first to have started one, the Gujarat Emergency Medical Services Authority (Gemsa), which has the power to set allocations for emergency services, gather information, plan schemes, set implementation guidelines, fix minimum technical qualifications for emergency personnel, issue training certificates, register trauma centres, and more.
Prescription: All states should have an emergency medical services council, with membership from the public as well as private sectors.
Emergency response in medical education curriculum
“Emergency care in India as a speciality has never received as much academic importance as other specialities,” says Bali. Resources (such as an adequate number of trained paramedics) remain a constraint.
Prescription: Make emergency services a priority in medical curriculum, including learning from other countries. Basic first-aid and life-support skills should be taught to all police personnel. “The easiest, lowest cost, and possibly (the) fastest way to create a force of people who are ‘first responders’... is to introduce a compulsory basic first-aid and life-support course at the high school level. Within five years, we will then have a huge force of first responders among common people,” says advocate Shaffi Mather, who works in the area of emergency services.
“Save Lives. Make hospitals safe in emergencies”—the posters read. The World Health Organization on Monday urged governments across the globe to build hospitals to withstand earthquakes and other disasters, dedicating World Health Day 2009 to this issue.
Last year’s devastating earthquake in China destroyed or damaged at least half of Sichuan province’s 6,800 hospitals, forcing tens of thousands to seek treatment elsewhere. Typhoon Fengshen damaged or destroyed 89 hospitals and health facilities in the Philippines last year. A 2007 tsunami damaged many hospitals and health facilities in the Solomon Islands, exposing communities to asbestos, WHO said. “Research shows that damage to health facilities can cost up to 60% of annual government health spending, so making facilities safe can sometimes be a means of actually saving money,” said Shin Young-soo, WHO regional director for the Western Pacific region. AFP
Several organizations offer training in emergency and disaster preparedness to civilians. Lifesupporters Institute of Health Sciences (www.lifesupporters.in), a Mumbai-based non-profit organization, spreads awareness about emergency medical services. It offers a first-responder certificate course and conducts emergency training in schools, among companies, police forces, etc. (some free or sponsored, others for a fee). AIIMS, Delhi (www.aiims.edu) and EMRI, Hyderabad (www.emri.in) offer training to doctors, nurses and paramedics as well as civilians. EMRI’s first-responder course for civilians is a one-day course that costs Rs700. Chitra Narayanan.
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