What's wrong with Delhi's Health infrastructure? Status report in High Court

The 267-page interim report has been drafted by the six-member committee headed by Dr SK Sarin, Director, Institute of Liver and Biliary Sciences (ILBS), Delhi and submitted to the Delhi High Court for observation.

The report deals with various aspects of medical services at the clinical establishments run by the State Government and Municipal Corporation of Delhi, further identifying its deficiencies and actionable measures on how to counter them.

It presents detailed data on the number of sanctioned posts vs vacancies in the hospitals for specialists, General Duty Medical Officers (GDMOs), Senior Resident Doctors, Junior Residents, Nursing and Paramedical staff, as well as the availability of manpower, ICUs, OTs and equipment status.

In its report, the panel has listed major deficiencies which need urgent remedial actions by the government including huge vacancies of medical professionals, shortage of critical faculty, lack of adequate ICUs and high-dependency beds and structured critical care services, inability to run emergency and trauma services along with no structured referral system for citizens and non-availability of medicines and surgical consumables.

Delving into these, the committee addressed the issue of 'efficient emergency health care services' as its top priority and laid down salient action points enlisting immediate, short-term and long-term measures to resolve the priority health issues in a time-bound manner. Immediate measures need to be implemented within 30 days, subject to model code of conduct, Short-term within 31-90 days, Intermediate within 91-365 days and Long-term within 1-2 years.

Following are the reported issues and the measures recommended by the panel:

Optimization of Existing Resources (Manpower and Equipment)

Immediate Measures

• Redistribution/ posting of consultants
• Shifting the unused equipment's to the facilities where expertise are available
• Non-functional Equipment should be made functional & ensure they are functional round the clock

Short term Measures

• Computerization of OPD registration and drug distribution counters

ICU and HDU beds Control Room establishment for real-time bed vacancy & ancillary facilities

Immediate Measures

• Additional 1024 ICU beds to be added
• Centralized dashboard manned by Medical professionals and trained executives for smooth execution of same (functional NIC dashboard to be upgraded in the control room).
• Referral coordinator to be tasked from each hospital for feeding real time data information.

Intermediate and Long-term measures

• Hospital to have 5% ICU and larger, 20% ICU beds

Human Resource

Immediate Measures

• To fill up 15% of the vacancies immediately by hiring faculty/consultants by respective Head of Institutions
• Salary and perks should be at par with regular employees.
• Empanelment of private visiting consultants in radiology, anaesthesia, critical care, orthopaedics, neurosurgery, etc.

Short term Measures

• 50% of the remaining vacant positions to be filled. 
• Regular selection through UPSC etc. should be streamlined and expedited

Intermediate and Long-term measures

• New posts should be created based on the projections given.
• Creation of additional cadres in level 3 and level 4 hospitals
• Creation of post of Manager at level 2 and above hospitals

Human Resources (Nursing and Para Medics)

Immediate Measures

• Hiring from empanelled private agencies.

Equipment

Immediate Measures

• Should opt for PPP model for ultrasound, CT Scan, MRI scan, etc. 
• On lease from a private vendor

Short term Measures

• Rate contract of any other govt. hospital could be utilized for immediate procurement
• Financial powers up to 5 crore to respective heads

Maintenance of High-End Equipment

Immediate Measures

• Every equipment's should be purchased with 5-year warranty and additional S year of paid CMC 
• Penalty clause should be included in the Rate Contract to compensate for downtime of equipment with provision of replacement equipment.

Suggestions for reducing stress on referral hospitals

Immediate Measures

• 15% of the equipment requirement should be procured
• Small and district hospital should be strengthened to provide round-the-clock emergency services.

Short term measures

• Availability of medicines and consumables should be ensured at all hospitals by providing financial power to the respective MSs

Intermediate and Long-term measures

• SRs from larger hospitals should be rotated to small hospitals
• Academic and non-academic SRs posts from smaller hospitals to be pooled in the larger hospital posts and recruitment to be carried out in larger hospitals attached with medical colleges.

Medicine and consumables

Immediate measures

• CPA should be strengthened
• Hospital should maintain minimum 20% inventory
• Financial powers to the MS and Directors to purchase medicines and consumables on daily basis
• Empaneling Local chemist and Jan Aushadhi kendra within a radius of 5 km for local purchase.

Short-term measures

• Space for Pharmacy and storage of consumable should be made available in all hospitals.
• Implementation of a system to maintain 3- month inventory of medicines and consumables for uninterrupted medical services.

Intermediate and Long term measures

• Central and storage of Procurement Agency (CPA) to be strengthened. and made accountable. All processes should be through e-file system.

Other Recommendations for Improving Medical Services in Delhi

Immedidate measures

• Introduction of Emergency (E)-OAK service.
• Allowing residents of Delhi to use Adhar Card in all private hospitals and get cashless facilities at CGHS rate. 
• Teaching faculty to provide tele consultation to the district hospitals 
• Full time MS/Director for all hospital

Short-term measures

• Starting TeleMedicine service.
• Delhi Health Authority should be set up.

Further recommendations include the creation of the Delhi State Health Authority, the completion of ongoing hospital projects, establishment of new medical colleges along with reliance on the private sector.

“The committee has reasons to believe that the recommendations of this report are doable, if enough budgetary provisions are made. In fact, the honorable High Court order has also stated that huge investments with structural reforms in the functioning of government hospitals is necessary to bring about a change,” the panel said.

In February this year, the Delhi High Court expressed serious apprehensions about the inadequate health infrastructure in Delhi hospitals and reprimanded the government for its failure to ensure the operational status of facilities.

“Where are things going wrong? Is proper infrastructure not there? Why are beds not available, what has happened in recent years? Just imagine, in four hospitals, a person does not get admission,” Justice Manmohan had said, adding “infrastructure was not keeping pace with the demand of the growing population of the city.” With this note, the High Court directed the State to constitute a committee of doctors to examine the hospitals run by the city government and come up with a solution. Based on the HC directive, the committee now filed its report.

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