Details for Reform Option "Maintenance of First Referral Units and Civil Hospitals, Assam"
Ten years of under funding at the Public Works Department (PWD) in Assam had led to lack of repairs and poor maintenance of hospital buildings. In order to improve the services in hospitals and to bring about partial modification in the health department, Government of Assam decided to set up a hospital management society for the medical college hospitals, hospitals attached to teaching institutions under the directorate of medical education, Assam as well as the state hospital, district hospitals and sub - divisional hospitals under the directorate of health services, Assam.
It was decided that a society be formed in accordance with the provisions of the Memorandum of Association (MOA) and the rules and regulations (bye laws) formed for this purpose. It had to be registered under Society Registration Act XXI, 1860. The Joint Director of Health Services in the District and the Sub Divisional Magistrate (SDM) and Health Officer (HO) of the sub- divisional head quarter, were responsible for taking necessary steps to form hospital management society for district hospital and sub- divisional hospital respectively as per provisions of the scheme within a period of one month.
Hospital management society was given the power to exercise autonomy to a large extent, on expenditure to be incurred from the revenue collected by the hospital in the form of donations, membership fees, user charges and government grants.
After such a Government Order was issued, the responsibility of maintenance of Bhugeswari Phukanani Civil Hospital (B.P. Civil Hospital), Nagaon and the First Referral Units (FRUs) was switched to the District Health and Family Welfare (DH&FW) agency in Nagaon, which was given the funding for the task. It was also authorised to approve repairs and renovations and select the contractor who would carry out the work.
It, in turn, formed hospital management societies at a local level and gave them the responsibility to carry out the work by preparing repair and cost estimates and submitting them to the DH&FW agency for approval.
Initially started as a pilot project, the programme has sustained itself. Hospital management societies have been formed in the B.P Civil Hospital and the 4 FRUs (Jakhalabanda, Hojai, Dhing and Lumding) in Nagaon District. The PWD and other government engineers provide technical help for the work. Through the funds from the government and user charges, commendable work is being carried out. The monthly collection from user fees alone in B.P Civil Hospital, Nagaon ranges between INR 2-3 lakhs. A few examples of the achievements of developmental works that have been carried out in B.P. Civil Hospital are:
* Repairing and renovation of blood bank and ultra-sonography machine.
* Repairing and renovation of medical ward.
* New electrification with fans in female medical ward and blood bank.
* Repairing of x-ray machines.
* Repairing and white washing of administrative building, district medical store, immunization centre and conference hall.
* Repairing and renovation of medical paying cabins and surgical paying cabins.
* Purchase of 100 beds with accessories.
* Purchase of two Maruti Van Ambulance.
Nagaon District, Assam
Three months. The programme began in 2002 and is continuing since then.
Decentralisation: Because financial and administrative responsibility for maintenance is now at a local level, work is being carried out more effectively and efficiently.
Improved facility: Improved maintenance and upgradation of hospital facilites.
Inclusive: Greater integration of community representatives.
Cost: Supervision charges have to be paid to the govt engineers, thus increasing the cost.
Decision Making: The executive committee does not have a full say in decisions which poses as a problem at times.
Contractual Staff: For cleaning only contractual staff can be hired not permanent.
Workload: Extra work is imposed on H& FW (doctors) due to staff shortage.
* Delegation of powers and availability of adequate funds.
* Availability of civil engineering support.
Who needs to be consulted
District Health and Family Welfare Agency, Nagaon
The program is running successfully since 2002. The activities have been sustainable through community participation like user charges, donation, from other sources like District Rural Development Agency (DRDA), Member of Legislative Assembly (MLAs) funds etc.
Chances of Replication
This option has been replicated already in other health facilities, using outside donations, user charges and other resources for renovating and building new hospital buildings in the state. This was done by the local management committees and not the PWD.
This reform has been a crucial factor in operationalising FRUs in the State. In conjunction with reforms allowing the District Health Agency to improve equipment supply and ensure manpower deployment.
Indrajit Pal, Former Programme Adviser, European Commission Technical Assistance, New Delhi. July 2002.
Last Updated: July 2006