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User fees for maintenance of medical equipment, Assam
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Subject Area="Infrastructure and Equipment." Objective="Maintenance of equipment."
Details for Reform Option "User fees for maintenance of medical equipment, Assam"
Summary

Background: Assam’s medical colleges and health centres have adequate hospital equipment but because of poor funding they could not afford to maintain this equipment or purchase consumables. Action: To overcome these constraints the Government of Assam introduced user fees for different investigations and curative procedures in hospitals. The user charges for various facilities vary from hospital to hospital. A few examples of user charges are: admission fee INR 10; pregnancy test INR 80; urine test INR 20; blood grouping INR 40; blood sugar INR 30; normal delivery INR 50; forceps delivery INR 50 and caesarean INR 500. The facilities now raise enough money to regularly service the equipment and purchase required consumables. Results: This option is in operation throughout the state and a few hospitals are raising enough funds to run the hospital activities smoothly without government budget allocation for contingencies. There are some hospitals where the collection from the user charges range between INR 1 lakh to INR 3 lakhs. The user charges have helped the hospital in maintaining their equipment and upgrading their facilities. Silent generators, hospital maintenance and expansion, renovation of blood banks, repair of x-ray machine, purchase and repair of mobile vans are some examples of how user charges are being utilised.

Cost No cost involved.
Place Medical colleges of Assam, district and sub-divisional hospitals, since 1994.
Time Frame Initially 5-6 months.
Advantages

Increased quality: People get quality services at lower cost and the staff becomes more accountable. Efficiency: There is less equipment breakdowns and hence the existing facilities are used more efficiently. More facilities: Silent generators, more mobile vans and blood storage facilities are being added in the hospitals due to user charges.

Challanges

No general trend in performance of the institutions: Some are collecting sufficient funds to operate medical equipment while other hospitals are not collecting fees efficiently. Lack of guidelines: No definite guidelines are available as to how to use the funds.

Prerequisites

Agreement on an appropriate fee structure, ensuring fees are not higher than in the private sector. Efficient organisation of fund collection e.g. calculating total fund requirements for regular maintenance and operation of equipment; a system for exemption of the poor is desirable.

Who needs to be consulted

State government, health & family welfare department, hospital committees.

Risks

Sustainability

Since 1994, this option is in operation in medical colleges and civil hospitals of the state. One of the most suitable, acceptable and sustainable reform options in the health sector.

Chances of Replication

User charges have been introduced in Public Health Centres (PHCs) and Community Health Centres (CHCs) too.

Comments

None.

Contact

Submitted By

Indrajit Pal, Former Programme Adviser, European Commission Technical Assistance Office, New Delhi. Last updated: July 2006

Status Active
Reference Files
GO No HLD 536-92-Pt-39 (PROD No 6).doc
GO No HLD 536-92-Pt-46 (PROD No 6).doc
Assam PPT.ppt Reform initiatives in the health sector- A power point presentation.
IMGP2088.JPG Photo of a blood bank
IMGP2104.JPG Photo of an operation theatre in Jhakla banda
IMGP2102.JPG Photo- Civil Hospital, Nagaon
Reference Links
 
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