ECHS: Seminar - Constraints deliberated threadbare- Satisfaction Level and Logistics Chain at loggerheads

As intimated in an earlier note I had been asked to present the ESM's view at a seminar in Chandimandir. This seminar was held on 15 and 16 Jul 2009 and was attended by the entire hierarchy concerned with the Scheme i.e. AG, DGMS Army, DG DC & W, MD ECHS MG ic Adm Western Comd, numerous Regional Directors, OIC Polycinics, Comdt Command Hospital Chandimandir, Dr Ajit K Nagpal Chairman Batra Hospital, Mr Sunil Goswami Vice President SITL, Mr P Ram Mohan MD Health Sprint and numerous others. Lt Gen Shammi Mehta Ex GOC in C Western delivered the keynote address. A large number of ESM from Chandigarh including Lt Gen Ranjit Dayal had been invited and participated very actively in the deliberations.

At the very outset I would like to state that the entire Services hierarchy involved in healthcare for ESM is very committed, totally positive and very well aware of our problems. Everything I said in my presentation was known and was being pursued vigorously albeit with an UNRESPONSIVE GOVERNMENT and an even more UNCARING BUREAUCRACY.

At the end of the Seminar, however, I was even more convinced that my views regarding the faulty structure i.e. the organisation as existing today are correct. As I have stated repeatedly the whole purpose of the ECHS was to reduce the load on Service hospitals. Yet the ECHS has been designed presently to use the existing structure of the armed forces. Entire manpower authorised to ECHS is contractual. Additional resources have NOT been authorised for ECHS purposes at MH (all types), Station HQs, Area HQs and Command HQs. Similarly additional resources for ECHS purposes have not been authorised for medical procurements including medicine at all levels of the logistics chain. Without going into too many details what this implies in a nutshell is as follows:

MD ECHS is responsible for the functioning of the Polyclinics through the Regional centres; however the Regional Centres function under the Command/Area/Sub Area with which they are co located. Administrative control of funds, accounting/audit/passage of bills etc is through Station HQs, Area HQs etc WITHOUT ADDITIONAL MANPOWER AND IN ADDITION TO THEIR BASIC TASK. Medical cover is in the first instance through existing Services Hospitals without augmentation. Similarly additional resources for ECHS purposes have not been authorised for medical procurements including medicine at all levels of logistics chain. Such multiple channels are bound to create problems. We thus have a weird situation where the ECHS has issued instructions that chronic patients requiring long-term treatment should be issued medicines for three months. But the DGMS Army has not only overruled these instructions but also vehemently opposed the very concept on ethical grounds during the Seminar. Similarly whereas ESM in numerous Metros have complained about being routed through Mil Hosps thus entailing numerous time consuming trips to Hosps like RR in Delhi and Ashvini in Mumbai, the Med hierarchy insists that the MH facilities be fully utilised before referral to civil empanelled hosps, patient convenience be damned. ARMED FORCES MEDICAL FACILITIES CANNOT BE OVERLOADED BECAUSE OF ESM AND YET BE UNDERUTILISED IN MAJOR HOSPS. Obviously there is a need to relocate surplus facilities at some stations to those areas where there has to be an acute deficiency to have initiated the very thought of the Ex Servicemens Contributory Health Scheme. There cannot be an overload and an underload concurrently. The reason why there is a surplus in popular and attractive stas with deficiencies in moffussil areas does not require much imagination.

The Army has considerable experience in running nearly similar institutions viz AGIF, AWHO and AWES. Granted that these Ests are not dependent on Govt funding but they too have stringent financial checks and balances. But they are run efficiently because they have one boss. Unity of Command is a well-established principle, then why this mix up. The Mil hierarchy continues to defend the present structure, as a reading of the Action Plan in Part three of this report will show. I suspect this is more because of Mil reticence in questioning Govt orders. I BELIEVE THE STRUCTURE REQUIRES A SERIOUS RELOOK.

In part one are the actions already in hand. In part two is the presentation made by me and part three is the action plan as per decisions taken after the Seminar. Seminar Part I, II and III: click me
Brig Sateesh Kuthiala (Retd)