Scheme for implementation of “24 × 7 Emergency Transportation Service for expecting mothers and sick infants through toll‐free Centralised Call Centre (102)” through private partners 2 Purpose 1. The Department of Health and Family Welfare (DoHFW), Government of West Bengal (GoWB) considers that the involvement and cooperation of the private and voluntary sectors in basic healthcare are key to optimising delivery mechanism of affordable and quality healthcare services. Public Private Partnership (PPP) is considered as the most competent strategy in this regard where the Government has to play the role of service provider at one end and on the other end, the services would be fully privatised and the role of Government would be limited to that of a regulator. It has been further identified that there is an unmet need in remote areas of West Bengal for emergency transportation services, especially for emergency obstetric and neonatal care. 2. The Ministry of Health and Family Welfare (MoHFW), Government of India (GoI) has already launched Janani Shishu Suraksha Karyakram (JSSK) for offering completely free and cashless services to pregnant women for deliveries (including normal & caesarean operations) and sick infants (upto 1 year after birth) in Government health institutions in both rural and urban areas. In order to meet this need, GoWB has decided to set up emergency transportation services by involving a reputed Private Sector Partner (PSP) to take up day-to-day operational management of ambulance services to be operated through a centralized call centre. The overall purpose of the endeavour is to provide a safety net for expecting mothers and sick infants by ensuring provision for complete 3 emergency transportation service and achieve the objective of the State relating to child and maternal mortality. Background 3. DoHFW, GoWB has taken several initiatives in the last few years to meet the increasing demand and expectations for improved health care services by the community at large. The vision, driving the DoHFW, focuses on improving the availability, accessibility and quality of health care services for the people in the State in general and for those, in particular, living in remote and difficult to reach areas of the State. This is in conformity with the ‘Plan of Action 2011-15’ of the DoHFW which inter alia focusses on the short term, medium term and long term goals of DoHFW. 4. Despite making significant strides over the last couple of years in the health sector, one of the key issues that the DoHFW is still confronted with is greater access to emergency response services with reference to maternal and infant care, especially for the benefit of pregnant women and sick newborns, through an organized and efficiently managed round the clock ambulance services. 5. It is a well-known fact that accessibility to emergency health care services especially emergency obstetric care is a critical factor to contribute significantly to the improvement of basic health indicators like Infant Mortality Rate (IMR), Maternal 4 Mortality Ratio (MMR) and increased levels of safe and institutional deliveries. In this context, It may be mentioned that there have been substantial improvements in the present status of the above key public health indicators in the State compared to last five/six years (as is evident below) due to various initiatives including greater public health interventions. Indicators Year State National 2005-06 48 Infant Mortality Rate (per 1000 live birth) 2014 31 42 2004-06 141 Maternal Mortality Ratio 2010-12 117 178 2008 26 Neo-natal Mortality Rate 2013 21 31 2007-08 49.2 Institutional Delivery (in %) 2013-14 77.7% Source: Sample Registration System ( Source: Sample Registration System (SRS), National Family Health Survey (NFHS)-2, District Level Household and Family Survey (DLHS)-3, GoI and Health on the March, 2012-13, DoHFW, GoWB However, amidst such progress in the public health indicators, one of the key challenges for the State, as mentioned above, is to have rapid and timely access to the health 5 facilities for expecting mothers and sick infants (upto 1 year after birth) especially in the remote areas of the State. A significant improvement in this critical area through an organized and competently managed emergency transportation services will certainly contribute to excel in the above indicators. Additionally, an organized emergency transportation is expected to suitably address the issue of accessibility in the remote areas of the State. 6. Objective The main objectives of the ambulance services are to: 8 Provide free emergency transportation service on 24x7 basis to all expecting mothers and sick infants (upto 1 year after birth) 8 Setting up of round the clock toll free tele-helpline (call facility from any mobile and land line) for booking ambulance service “102” — through call centre 8 Offer emergency management services for pre hospital emergencies during transportation. 7. Expected Benefits Í Increased level of safe and institutional deliveries Í Increased access to Sick Neonatal Care Unit (SNCU) and Sick Neonatal Stabilisation Unit (SNSU) 6 Í Minimising the out of pocket expenditure of the JSSK beneficiaries (all expecting mothers and infants upto 1 year after birth) Í Enhanced utilization of public health infrastructure. 8. Existing services The existing ambulance service project, titled ‘Nishchay Yan’ is operative in West Bengal with the funding support from DoHFW. It is functioning as an umbrella scheme, where empanelled vehicles are utilised for transportation of hospital emergency cases. These empanelled vehicles are generally called “Nishchay Yan”. All commercially registered vehicles (private ambulances, PPP ambulances, ambulances purchased under MP LAD/BEUP schemes or by local bodies under any other scheme/fund or other vehicles owned by private owners) are empanelled under this scheme. The scheme is operative in all the Districts of the State with an estimated total of 1513 empanelled vehicles (as of December 2014) comprising of around 1233 private vehicles, 15 Government owned ambulances and the balance being other ambulances operated through PPP mode. All pregnant women and sick infants residing in the State of West Bengal are eligible to avail this service under JSSK. As per the norms of JSSK, the eligible beneficiaries do not pay user charges for the transportation service. Transportation from residence to the hospital, transportation for referral to higher tier hospital, if required and transportation 7 back to residence after discharge from hospital, is covered under this scheme. The vehicle owner gets reimbursement for transportation cost of the JSSK beneficiaries. The DoHFW has spent an amount of Rs. 30.45 crores for the year 2012-2013 and Rs. 42.22 crores for the year 2013-2014 for free referral transportation services under JSSK. The State has established a toll free tele-help line system to enable people in need to avail of these “Nishchay Yan”. District head-quarter based call centres, manned by different non-government agencies in different districts, with toll free number of ‘102’ have been made functional for liaisoning with the ambulance operators and facilitating the beneficiaries to avail the service. Contact of the call centre is established with the mobile numbers of the drivers of empanelled vehicles. A provisional allocation of ambulances for each of the Districts in the State is provided herewith. The allocation of the number of ambulances in each District has been calculated based on the trend of institutional deliveries in the last two years. Accordingly the District-wise allocation of Ambulances is provided. However, it may be mentioned here that the deployment of Ambulances for each District may vary considering the need and requirement in each District. 8 District Population No. of No. of No. of Total no. of (in lakhs) Deliveries Deliveries Blocks Ambulances as of 2011 (2012-13) (2013-14) Bankura 35.97 45382 48760 22 41 Bardhaman 77,18 96953 141487 31 98 Birbhum 35.02 51468 50168 19 42 Howrah 48.50 48291 51677 14 41 Hooghly 55.19 56070 65324 18 50 Murshidabad 71.04 78725 117587 26 81 Nadia 51.68 67296 68668 17 56 North 24 Parganas 100.10 65497 65681 22 54 Paschim Medinipur 59.13 64999 66039 29 56 Purba Medinipur 50.95 55270 62978 25 49 Purulia 29.30 38558 44175 20 36 South 24 Parganas 81.62 60469 77144 29 60 South Bengal 695.68 728978 859688 272 664 Cooch Behar 28.19 37504 39153 12 31 Darjeeling 18.47 34146 29553 12 28 Jalpaiguri + 38.73 42687 43872 13 38 Alipurduar Dakshin Dinajpur 16.76 19151 20569 8 18 Uttar Dinajpur 30.07 30324 33985 9 26 9 District Population No. of No. of No. of Total no. of (in lakhs) Deliveries Deliveries Blocks Ambulances as of 2011 (2012-13) (2013-14) Malda 39.89 43117 53787 15 40 North Bengal 172.11 206929 220919 69 181 Total (North & South 867.79 935907 1080607 341 845 Bengal) Kolkata 44.97 84004 93531 — 55 Total for West Bengal 912.76 1019911 1174138 900 A list of the Government hospitals/ health care institutions is annexed. Newly notified DPs with delivery load of 2013-14 & 2014-15 Total Total SN District Name of the Facility Cat Category Del_2013- Del_2014-15 14 1 Bankura Akui PHC PHC BEmOC 6 2 2 Bankura Amarkanan RH CHC CEmOC 1024 1284 3 Bankura Amdangra PHC PHC BEmOC 12 193 4 Bankura Amjhuri BPHC BPHC BEmOC 278 409 5 Bankura Bankura Sammilani MCH MCH CEmOC 22018 21515 6 Bankura Barjora BPHC BPHC BEmOC 708 461 7 Bankura Beliatore PHC PHC BEmOC 212 164 8 Bankura Bishnupur DH DH CEmOC 5376 5027 9 Bankura Chhatna BPHC BPHC