REPORT NO. 71
PARLIAMENT OF INDIA RAJYA SABHA
DEPARTMENT-RELATED PARLIAMENTARY STANDING COMMITTEE ON HEALTH AND FAMILY WELFARE
SEVENTY FIRST REPORT The Functioning of Central Government Health Scheme (CGHS) (Ministry of Health and Family Welfare)
(Presented to the Rajya Sabha on 6th August, 2013) (Laid on the Table of Lok Sabha on 6th August, 2013)
Rajya Sabha Secretariat, New Delhi August, 2013/Sravana, 1935 (Saka) Website:http://rajyasabha.nic.in E-mail:[email protected] Hindi version of this publication is also available
PARLIAMENT OF INDIA RAJYA SABHA
DEPARTMENT-RELATED PARLIAMENTARY STANDING COMMITTEE ON HEALTH AND FAMILY WELFARE
SEVENTY FIRST REPORT
The Functioning of Central Government Health Scheme (CGHS) (Ministry of Health and Family Welfare)
(Presented to the Rajya Sabha on 6th August, 2013) (Laid on the Table of Lok Sabha on 6th August, 2013)
Rajya Sabha Secretariat, New Delhi August, 2013/Sravana, 1935 (Saka)
CONTENTS
PAGES
1. COMPOSITION OF THE COMMITTEE ...... (i)-(viii)
Composition of the Committee on Health and Family Welfare (2010-11) ...... (i)-(ii) Composition of the Committee on Health and Family Welfare (2011-12) ...... (iii)-(iv) Composition of the Committee on Health and Family Welfare (2012-13)...... (v)-(vi) Composition of the Sub-Committee II on CGHS (2010-11) ...... (vii) Composition of the Sub-Committee II on CGHS (2011-12) ...... (viii)
2. PREFACE ...... (ix)-(x)
3. ACRONYMS ...... (xi)
4. REPORT ...... 1—23
5. RECOMMENDATIONS/OBSERVATIONS — AT A GLANCE ...... 24—34
6. MINUTES ...... 35—51
7. ANNEXURES ...... 53—63
COMPOSITION OF THE COMMITTEE ON HEALTH AND FAMILY WELFARE (2010-11)
RAJYA SABHA 1. Shri Brajesh Pathak — Chairman 2. Shri Janardan Dwivedi 3. Shrimati Viplove Thakur 4. Dr. Vijaylaxmi Sadho 5. Shri Balbir Punj 6. Dr. Prabhakar Kore @7. Shrimati Brinda Karat 8. Shrimati Vasanthi Stanley 9. Shri Rasheed Masood *10. Shrimati B. Jayashree
LOK SABHA 11. Shri Ashok Argal 12. Shrimati Sarika Devendra Baghel Singh 13. Shri Vijay Bahuguna 14. Shrimati Tabassum Hasan 15. Dr. Sanjay Jaiswal 16. Shri S. R. Jeyadurai 17. Dr. Kruparani Killi 18. Shri Nimmala Kristappa 19. Dr. Tarun Mandal 20. Shri Datta Meghe 21. Dr. Jyoti Mirdha 22. Dr. Chinta Mohan 23. Shrimati Jayshreeben Patel 24. Shri R. K. Singh Patel 25. Shri M. K. Raghavan 26. Shri J. M. Aaron Rashid 27. Dr. Anup Kumar Saha 28. Dr. Arvind Kumar Sharma 29. Shrimati Meena Singh 30. Shri Pradeep Kumar Singh 31. Shri Ratan Singh
@ Ceased to be a Member w.e.f. 18th August, 2011. * Nominated to the Committee w.e.f. 21.9.2010.
(i) (ii)
SECRETARIAT Shrimati Vandana Garg, Additional Secretary Shri R. B. Gupta, Director Shrimati Arpana Mendiratta, Joint Director Shri Dinesh Singh, Assistant Director Shri Satis Mesra, Committee Officer COMPOSITION OF THE COMMITTEE ON HEALTH AND FAMILY WELFARE (2011-12)
RAJYA SABHA 1. Shri Brajesh Pathak — Chairman *2. Shri Janardhan Dwivedi %3. Shrimati Viplove Thakur 4. Dr. Vijaylaxmi Sadho 5. Shri Balbir Punj 6. Dr. Prabhakar Kore 7. Shrimati Vasanthi Stanley ^8. Shri Rasheed Masood 9. Shrimati B. Jayashree 10. Shri Derek O’Brien
LOK SABHA 11. Shri Ashok Argal &&12. Shrimati Harsimrat Kaur Badal @13. Shri Vijay Bahuguna 14. Shrimati Raj Kumari Chauhan 15. Shrimati Bhavana Gawali 16. Dr. Sucharu Ranjan Haldar 17. Dr. Monazir Hassan 18. Dr. Sanjay Jaiswal 19. Shri S. R. Jeyadurai 20. Shri P. Lingam 21. Shri Datta Meghe 22. Dr. Jyoti Mirdha 23. Dr. Chinta Mohan 24. Shri Sidhant Mohapatra 25. Shrimati Jayshreeben Kanubhai Patel 26. Shri M. K. Raghavan 27. Shri J. M. Aaron Rashid 28. Dr. Arvind Kumar Sharma 29. Shri Radhe Mohan Singh 30. Shri Ratan Singh 31. Dr. Kirit Premjibhai Solanki
* Ceased to be a Member w.e.f. 27th January, 2012 and re-nominated to the Committee on 2nd February, 2012. % Vacant vide resignation w.e.f. 2nd April, 2012. ^ Vacant vide resignation w.e.f. 9th March, 2012 and renominated as Member w.e.f. 4th May, 2012 and Member of Sub- Committee II on CGHS w.e.f. 1st June, 2012. && Ceased to be a member w.e.f. 29th June, 2012. @ Vacant vide resignation w.e.f. 30th April, 2012.
(iii) (iv)
SECRETARIAT Shri P.P.K. Ramacharyulu, Joint Secretary Shri R. B. Gupta, Director Shrimati Arpana Mendiratta, Joint Director Shri Dinesh Singh, Assistant Director COMPOSITION OF THE COMMITTEE ON HEALTH AND FAMILY WELFARE (2012-13)
RAJYA SABHA 1. Shri Brajesh Pathak — Chairman 2. Dr. Vijaylaxmi Sadho *3. Dr. K. Chiranjeevi 4. Shri Rasheed Masood 5. Dr. Prabhakar Kore 6. Shri Jagat Prakash Nadda 7. Shri Arvind Kumar Singh &8. Shri D. Raja 9. Shri H. K. Dua 10. Shrimati B. Jayashree
LOK SABHA @11. Shri Ashok Argal 12. Shri Kirti Azad 13. Shri Mohd. Azharuddin 14. Shrimati Sarika Devendra Singh Baghel 15. Shri Kuvarjibhai M. Bavalia 16. Shrimati Priya Dutt 17. Dr. Sucharu Ranjan Haldar 18. Mohd. Asrarul Haque 19. Dr. Monazir Hassan 20. Dr. Sanjay Jaiswal 21. Dr. Tarun Mandal 22. Shri Mahabal Mishra 23. Shri Zafar Ali Naqvi 24. Shrimati Jayshreeben Patel 25. Shri Harin Pathak 26. Shri Ramkishun 27. Dr. Anup Kumar Saha 28. Dr. Arvind Kumar Sharma 29. Dr. Raghuvansh Prasad Singh 30. Shri P.T. Thomas #31. Shri Chowdhury Mohan Jatua
* Ceased to be Member of the Committee w.e.f. 28th October, 2012. & Ceased to be Member of the Committee w.e.f. 24th July, 2013. @ Ceased to be Member of the Committee w.e.f. 9th January, 2013. # Nominated as a Member to the Committee w.e.f. 14th December, 2012.
(v) (vi)
SECRETARIAT Shri P.P.K. Ramacharyulu, Joint Secretary Shri R. B. Gupta, Director Shrimati Arpana Mendiratta, Joint Director Shri Dinesh Singh, Deputy Director Shri Pratap Shenoy, Committee Officer COMPOSITION OF SUB-COMMITTEE–II (CGHS) OF DEPARTMENT-RELATED PARLIAMENTARY STANDING COMMITTEE ON HEALTH AND FAMILY WELFARE (2010-11)
RAJYA SABHA 1. Shri Rasheed Masood — Convenor 2. Shri Balbir Punj 3. Dr. Prabhakar Kore 4. Shrimati Vasanthi Stanley
LOK SABHA 5. Shri Vijay Bahuguna 6. Dr. (Shrimati) Kruparani Killi 7. Shri M. K Raghavan 8. Shri J. M. Aaron Rashid 9. Dr. Arvind Kumar Sharma 10. Shri Ratan Singh 11. Shri Pradeep Kumar Singh 12. Dr. Anup Kumar Saha 13. Shrimati Meena Singh 14. Shrimati Tabassum Hasan 15. Shrimati Sarika Devendra Singh Baghel
SECRETARIAT Shrimati Vandana Garg, Joint Secretary Shri R. B. Gupta, Director Shrimati Arpana Mendiratta, Joint Director Shri Dinesh Singh, Assistant Director
(vii) COMPOSITION OF SUB-COMMITTEE–II (CGHS) OF DEPARTMENT-RELATED PARLIAMENTARY STANDING COMMITTEE ON HEALTH AND FAMILY WELFARE (2011-12)
RAJYA SABHA 1. Shri Balbir Punj — Convenor 2. Dr. Prabhakar Kore 3. Shrimati Vasanthi Stanley 4. Shri Rasheed Masood
LOK SABHA 5. Shrimati Raj Kumari Chauhan 6. Shri M. K Raghavan 7. Shri J. M. Aaron Rashid 8. Shri Arvind Kumar Sharma 9. Shrimati Bhavana Gawali 10. Shri P. Lingam 11. Shri Sidhant Mohapatra 12. Dr. Kirit Premjibhai Solanki
SECRETARIAT Shri P.P.K. Ramacharyulu, Joint Secretary Shri R. B. Gupta, Director Shrimati Arpana Mendiratta, Joint Director Shri Dinesh Singh, Deputy Director Shri Pratap Shenoy, Committee Officer
(viii) PREFACE
I, the Chairman of the Department-related Parliamentary Standing Committee on Health and Family Welfare, having been authorized by the Committee to present the Report on its behalf, do hereby present this Seventy-first Report of the Committee on the Functioning of Central Government Health Scheme (CGHS) of the Department of Health and Family Welfare.
2. The Committee (2010-11) in its meeting held on 6th May, 2011 decided to constitute a Sub-Committee to examine the Functioning of Central Government Health Scheme (CGHS). Subsequently since the deliberation on the subject remained inconclusive, the Committee (2011-12) in its meeting held on 21st September, 2011 again constituted a Sub-Committee on the subject.
3. The Sub-Committees (2010-11 and 2011-12) constituted to examine the Functioning of Central Government Health Scheme (CGHS) deliberated on the subject in its meetings held on 15th June, 27th June, 26th July, 11th October, 2011 and 6th June, 2012. The main Committee (2012-13) also deliberated on the subject on 9th January, 2013.
4. During the course of examination of the subject, the Sub-Committee heard the views of the Additional Secretary and Director General (CGHS), Department of Health and Family Welfare on 27th June, 2011. The Sub-Committee also had the benefit of the views of certain stakeholders during its meetings held on 26th July, 2011 and 11th October, 2011 (List of stakeholders/experts at Annexure-I). Thereafter, the main Committee also heard the views of Additional Secretary and Director General (CGHS), Department of Health and Family Welfare, Ministry of Health and Family Welfare on 9th January, 2013 along with Director Generals of Armed Forces Medical Services (AFMS), Ministry of Defence; Railway Health Services (RHS), Ministry of Railways and Employees State Insurance(ESIC), respectively on the subject.
5. During the finalization of its Report, the Committee relied upon the following documents/ papers:–
(i) Status Note on CGHS received from Department of Health and Family Welfare;
(ii) Oral Evidence tendered by Additional Secretary and DG (CGHS), Department of Health and Family Welfare;
(iii) Oral Evidence tendered by Director General of Armed Forces Medical Services (AFMS), Ministry of Defence; Director General of Railway Health Services (RHS), Ministry of Railways and Director General of Employees State Insurance (ESIC);
(iv) Written submissions submitted by stakeholders; and
(v) Replies to the questionnaires received from the Department of Health and Family Welfare.
6. The Committee considered the Draft Report and adopted the same in its meeting held on 26th July, 2013.
(ix) (x)
7. For facility of reference and convenience, observations and recommendations of the Committee have been printed in bold letters in the body of the Report.
BRAJESH PATHAK, NEW DELHI; Chairman, July 26, 2013 Department-related Parliamentary Standing Sravana 4, 1935 (Saka) Committee on Health and Family Welfare. ACRONYMS
1. AAP – Annual Acquisition Plan 2. AFMS – Armed Forces Medical Service 3. AMA – Authorized Medical Attendant 4. AYUSH – Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy 5. CGHS – Central Government Health Scheme 6. CMO – Chief Medical Officer 7. CSMA – Central Services Medical Attendance 8. DNB – Diplomate of the National Board 9. DLC – Differential leukocyte count 10. ECG – Electrocardiogram 11. ESIC – Employees State Insurance Scheme 12. GDMOs – General Duty Medical Officers 13. IRMS – Indian Railway Medical Service 14. IVF – In-Vitro Fertilization 15. MSDs – Medical Store Depots 16. MSO – Medical Stores Organisation 17. ME – Medical Equipment 18. NABL – National Accreditation Board for Testing and Calibration Laboratories 19. NABH – National Accreditation Board for Hospitals 20. NCR – National Capital Region 21. NFSG – Non Functional Selection Grade 22. OPD – Out Patient Department 23. PRO – Public Relations Officer 24. PVMS – Priced Vocabulary of Medical Stores 25. PPP – Public Private Partnership 26. PIB – Press Information Bureau 27. TLC – Total Leucocyte Count 28. UTI-TSL – Unit Trust of India-Technology Services Limited
(xi)
1
REPORT
CENTRAL GOVERNMENT HEALTH SCHEME The “Central Government Health Scheme” (CGHS) provides comprehensive health care facilities to the Central Government employees and pensioners their dependents residing in CGHS covered cities, sitting and retired Members of Parliament, freedom fighters etc. 2. Central Government Health Scheme started in New Delhi in 1954 is now in operation in 25 cities viz. Allahabad, Ahmedabad, Bangalore, Bhubaneshwar, Bhopal, Chandigarh, Chennai, Delhi, Dehradun, Guwahati, Hyderabad, Jaipur, Jabalpur, Kanpur, Kolkata, Lucknow, Meerut, Mumbai, Nagpur, Patna, Pune, Ranchi, Shillong, Trivandrum and Jammu. Medical facilities are provided through Wellness Centres/polyclinics under Allopathic, Ayurveda, Yoga, Unani, Sidha and Homoeopathic systems of medicines. As per information furnished by the Department of Health and Family Welfare, 248 allopathic Wellness Centres, 19 polyclinics, 78 Ayush dispensaries/units; 3 Yoga Centres; 65 Laboratories; 17 Dental Units along with dialysis and maternity units are working under CGHS. 3. Besides, CGHS beneficiaries enjoy medical facilities in around 400 private empanelled hospitals and around 170 diagnostic Centres in 25 cities in the country. The city-wise distribution of Wellness Centres/beneficiaries/card holders is at Annexure-II.
MEMBERSHIP OF CGHS 4. As informed by the Department as on 31st March, 2008, CGHS had 8,49,816 card holders with a beneficiary base of 32,08,655. The CGHS is applicable to the following: · All Central Government employees and their dependant family members residing in CGHS covered areas. · Central Government Pensioners and their eligible family members getting pension from Central Civil Estimates · Sitting and Ex-Members of Parliament. · Ex-Governors and Lt. Governors · Freedom Fighters · Ex-Vice-Presidents · Former Prime Ministers · Sitting and Ex-Judges of the Supreme Court and High Courts · Employees and pensioners of certain autonomous organizations in Delhi. · Journalists (in Delhi) accredited with PIB (for OPD and at RML Hospital) · Delhi Police Personnel in Delhi only · Railway Board employees 5. The Committee was also apprised that the expenditure incurred on CGHS during Eleventh Five year Plan was Rs 276.87 crore and Rs 2790.38 crore under Plan and Non-Plan heads 2 respectively. For the year 2012-13, the expenditure incurred was 66.16 crores under the plan head. A table showing details of expenditure incurred during 2007-12 is at Annexure-III.
FACILITIES AND SERVICES UNDER CGHS 6. CGHS provides comprehensive health care services to its diverse group of beneficiaries. The basic medical facilities like Out Patient Care are provided at the wellness centre level and In- Patient care through the Government hospitals in 25 locations where CGHS is in operation across the country. The specialized services made available to beneficiaries at CGHS Wellness Centres are as under:– · Emergency service at 6 earmarked Wellness Centres Domiciliary/Home visits when required to attend patients who are unable to visit the Wellness Centre. · Specialist Consultation and other special treatment on scheduled date. · Laboratory, Radiological investigation facilities. · Special care for senior citizens by means of separate queues/counters at every level of transaction. · Geriatric Units/facilities having various specialties treatment running for old age ailments at 2 Wellness Centres in Delhi namely Janakpuri and Timarpur, · Preventive Health Check-up at earmarked CGHS Wellness Centres in order to diagnose hitherto undetected illness and also for Health Education. · AYUSH dispensary/Units are running with Yoga Centres at different Wellness Centres. 7. The other components of the Scheme include purchase, storage, distribution and supply of medicines; health education; empanelment of private hospitals and diagnostic centres for providing best quality health care. OPD services in private recognized hospitals is not permitted except in case of Satellite cities of Delhi, viz., Noida, Gurgaon, Faridabad and Ghaziabad, wherein the CMO in-charge can directly refer the beneficiaries to recognized hospitals.
Dialysis Facility 8. A Standalone Haemodialysis Centre at Sadiq Nagar CGHS wellness centre was started as a pilot project under Public Private Partnership with Apollo group of hospitals exclusively for CGHS beneficiaries (both pensioners and serving) and has been functional since 1st September 2010. 9. It has the capacity to dialyze up to 21 cases of chronic renal failure per day with 7 functional dialysis machines and is operational from 7 A.M. to 8 P.M. for 310 days in a year. This endeavor is a pioneering initiative and first of its kind in CGHS.
Preventive Health Check-up Scheme 10. The Committee was apprised that keeping in mind the preventive aspect of chronic illnesses/health issues and on the basis of feedback received from the pilot project on Preventive health check up scheme being run at R.K Puram-V wellness centre, Delhi, these services have now been expanded to 8 other CGHS Wellness Centres in Delhi-NCR which are functional from 1st January 2012. The beneficiaries above the age of 40 years are covered under this project. 11. During the course of presentation in the meeting held on 9th April, 2012 pertaining to Demands for Grants 2012-13, the Director, CGHS highlighted the major initiatives taken by the Department under CGHS. He informed that allopathic Wellness Centres in all cities have been 3 computerized due to which there is easy availability of medicines at the Wellness Centres and an option to take treatment/medicines from any the Wellness Centres in any CGHS city without any special permission. In addition, IVF facility for the childless CGHS beneficiaries; inclusion of minor children of dependent widowed/separated daughter as dependant family member for CGHS; revision of rates for coronary stents and hearing aids and expansion of preventive Health Check Up scheme to 8 Wellness Centres (two in each zone) in Delhi/NCR have also been started. Further, he also discussed the future plans which included setting up of Delhi type Hind-Lab facilities in Mumbai and Bengaluru; review of empanelment process and package rates in 2012; preparation of CGHS manual; introduction of Health Insurance Scheme for Central Government employees and pensioners.
12. The Committee has also been informed that CGHS has the provision for reimbursement of expenditure incurred on Ambulance facilities on the basis of recommendation of the treating doctor that conveyance of the patient by any other mode would endanger the patient’s life or would grossly aggravate his/her condition and all journey is undertaken within the same city. Further, it was also stated that CGHS is in process of procuring two new ambulances equipped with Advanced Life Support system for the VIPs in Delhi.
13. As regards cashless scheme, the Committee has been informed that the CGHS pensioner beneficiaries as well as MPs, ex-MPs etc. are provided cashless medical facilities in all CGHS empanelled private hospitals/diagnostic Centres. Serving beneficiaries are also entitled for cashless benefits from the empanelled private hospital when admitted under emergency situations.
SCOPE AND PURPOSE OF THE SCHEME 14. The Committee took note of growing resentment among the beneficiaries about the prevailing inadequacies and red-tapism in delivery of the services under the Central Government Health Scheme and decided to make a detailed study of the scheme threadbare and to suggest measures to plug the existing loopholes and steps to strengthen the scheme. The Committee is of the firm view that health is not just the absence of disease but it is determined by social and mental well-being and is the mark of the functional efficiency of the individual. If the Government will shy away from their responsibility of providing good health to its employees, the foundation of the whole system will get crippled. To begin with, the Committee in order to have wider perception of the shortcomings in the functioning of Central Government Health Scheme, decided to call for comments from various stakeholders and accordingly released a press release seeking public opinion on the subject. The Committee received a large number of representations in response to its press release and suggestions made in the representations from stakeholders have been duly included in the succeeding paras of the Report. Besides, the Committee heard witnesses from various Associations, other stake holders, held meetings with the officers of Department of Health and Family Welfare to get an insight into general and specific grievances. The Committee also visited various CGHS Wellness Centres as well as Wellness Centres at Guwahati, Imphal, Chennai, Bangalore, Shimla and Chandigarh and held discussions with Doctors/beneficiaries at each centre to observe the functioning of the health scheme as per the vision and mission of CGHS. 15. Although CGHS has shown improvement since last 10 years, still many inadequacies exist in providing the desired facilities to the beneficiaries and laxity at various levels. In this backdrop, the Committee has focused on the key problem areas which are hampering the smooth functioning of CGHS and has made its observations and recommendations on various aspects of drug procurement, grievance redressal mechanism, reimbursement procedure, emergency care, specialist consultations, etc. Necessary suggestions have also been made on various issues to improve the functioning of CGHS, which are discussed in succeeding paras. 4
GENERAL PROBLEMS 16. The Committee, during the course of consideration of the subject, has received several representations from beneficiaries across the country voicing their dissatisfaction over the general functioning of Central Government Health Scheme including inadequacy of infrastructure and administrative issues at the Wellness Centres. 17. In view of a large number of complaints received, the Committee undertook visits to some of the Wellness Centres in Delhi/NCR, Chennai, Bangalore, Guwahati and Shillong to make on the spot study of their functioning and to have first hand information and to have interaction with various stakeholders to know the ground realities. The issues which came to the notice of the Committee have been discussed in the succeeding paras.
SHORTAGE OF DOCTORS AND STAFF 18. One of the major complaints received as regards the CGHS was shortage of doctors, paramedical and other assisting staff in most of the CGHS Wellness Centres. From a perusal of the vacancy position in many CGHS Wellness Centres, the Committee noted that many posts are lying vacant since long. What adds further to the woes of the beneficiaries is the fact that doctors and other staff frequently come late to the Wellness Centres. All this results in over-crowding of the centres. Many beneficiaries also complained that often they have to return unattended which besides causing physical and mental agony also results in extra burden monetarily on the patient owing to transportation charges on account of multiple visits. Many beneficiaries also complained about non availability of specialist doctors in these centres. 19. During the course of the meeting held on 27th June 2011, the representative of the Department of Health and Family Welfare had stated that in Delhi out of 670 sanctioned posts of GDMOs 56 posts are vacant and out of 614 filled positions 63 are contractual appointees. The scheme of appointing doctors on contract basis has been extended to other cities too. During its deliberation with stakeholders on the subject, at its meeting held on 26th July, 2011, it was highlighted that the provision of doctors should commensurate with the number of beneficiaries at the Wellness Centres. Further, to ensure availability of doctors at Wellness Centres at all the times there should be replacement or leave reserves for them. 20. The Committee was also informed that there is acute shortage of clerical staff in CGHS Wellness Centres in Delhi and efforts have been made to get the sanctioned posts filled up through SSC and the Ministry has already taken action to deploy data entry operators in those Wellness Centres where regular clerical staff are not posted. However, the Committee found a different picture during its visit to some of the Wellness Centres. The Committee noted that at Dwarka Wellness Centre, Delhi, the staff strength was less than the sanctioned strength. The contracts of the contractual doctors and other clerical staff were not revoked after the expiry. A similar situation was at Ghaziabad Wellness Centre too. The Committee was apprised that the Centre caters to around 41,000 beneficiaries. However, the doctors and staff strength are not in commensurate with the beneficiaries attending the dispensary. The beneficiaries present in the wellness centre complained about heavy rush in the Centre at all the times and delay in other services too. At Noida Sector 11 Wellness Centre also Committee witnessed the same status pertaining to staff strength, lack of infrastructure and basic amenities, heavy rush etc. 21. To have first hand information as regards the working of CGHS Wellness Centres located in other cities the Committee undertook study visits to Tamil Nadu, Karnataka, Himachal Pradesh and Chandigarh and visited CGHS Centres there. The Additional Director, CGHS, Chennai apprised the Committee about the facilities provided by 14 CGHS Wellness Centres located in the State and also focused on the need for appointment of more doctors, data entry operators and operation 5 manager for Wellness Centres to cater to the needs of 14,834 serving employees and 13,340 pensioners besides MPs, ex-MPs, freedom fighters and retired judges. The Committee also heard views of Chairman, Coordination Committee of the Central Government Pensioners Associations, Karnataka, on the functioning of CGHS. He submitted that shortage of doctors was leading to long waiting time which could be reduced by laying down a time frame of 15 minutes per patient and 5 minutes for follow up cases on average till the revised Staff Inspection Unit (SIU) formula is prescribed to augment the staff strength. 22. The Department, in reply to a query regarding steps being taken to fill up the vacancies, has informed that for filling up of the vacancies of GDMOs and Specialists, requisitions have been sent to UPSC and as a short term measure, appointment of retired GDMOs is being made from time to time on contract basis. For filling up of the vacancies of pharmacists, applications were called and further action to select the candidates is under process. For other vacancies in Group ’C’, action has been initiated as required in accordance with the Recruitment Rules. Further, it has also been informed that as per the SIU norms, one doctor is posted for beneficiaries attendance of 75 per day and incremental increase of doctors is provided as attendance increases and these are being broadly followed in Delhi/NCR. 23. The Committee fails to understand as to why there still exists a huge gap between in-position strength and sanctioned posts of doctors and supporting staff despite the Departments’ claim that the contractual appointments of retired doctors is being made to fill up the vacancies. The fact about this mismatch was brought to the notice of the Committee by the beneficiaries while deposing before it as also during the study visit to some of the Wellness Centres. The same holds true for vacancies in paramedical and other staff also. If all the vacancies had been filled up by contractual appointments as claimed by the Department, the vacancies would have ceased to exist. The Committee is of the opinion that vacancies, irrespective of any category cause overstressing of the existing manpower and directly or indirectly are bound to affect the quality of services rendered to the beneficiaries by the Wellness Centres. CGHS has been established with the vision to cater to health needs of the beneficiaries and shortage of manpower will handicap the successful running of CGHS. The Committee, therefore, recommends that the Department should reassess the strategies adopted to fill up the vacancies and come up with realistic measures so that the shortage of doctors and paramedical staff in CGHS Wellness Centres can be overcome. Efforts should also be made to increase the availability of specialist doctors or consultants in various fields at these Wellness Centres keeping in mind the alarming increase in the number of patients suffering from high blood pressure, diabetes, and other critical illnesses. Adequate provision for leave reserve vacancies for all posts should be made so that substitutes could be provided in case of any one proceeding on leave. 24. The Committee recommends that vigorous efforts should be made by the Department for filling up of all the existing vacancies of GDMOs and specialists and other paramedical staff. The Committee also recommends that adequate provision of leave reserve should be made for doctors and other assisting staff so that the beneficiaries do not have to suffer due to absence of doctors and other assisting staff.
PUNCTUALITY
25. Another issue which needs urgent attention of the Department is lack of punctuality among doctors and other allied staff members. In the meeting of the Committee held on 26th July, 2011, witnesses informed the Committee that most of the doctors never come in time to the Wellness Centres. The Committee has also received numerous complaints regarding the non-availability of doctors at CGHS Wellness Centres. Few beneficiaries also complained that doctors often leave their 6 rooms for long durations resulting in further increase in rush and suggested that lunch break time for doctors and staff should be fixed and clearly indicated on the notice board for the information of the patients. 26. The Committee conveys its anguish at the absence of work discipline in the discharge of duties by the doctors and other supporting staff in the Wellness Centres. The complaints from various stakeholders imply that due to lack of punctuality on the part of doctors and paramedical staff, the beneficiaries have to wait for hours for getting registered and examined. Through written as well as the oral representations, suggestions of undertaking surprise visit to check the punctuality of the staff members by the concerned authorities and introduction of biometric system of attendance have been given by various experts and stakeholders. The Committee, therefore, emphasizes that the above mentioned measures must be introduced to abate this problem of late comers. Besides, period of tea/lunch breaks should be restricted and notified on the Notice Board in the Wellness Centres so that the beneficiaries do not have to wait for longer period.
BEHAVIOURAL ISSUES 27. Another aspect which was brought to the attention of the Committee was the unsympathetic attitude and indifferent approach of doctors and other staff towards patients’ problems. The beneficiaries informed that patients are not examined properly and medicines are prescribed without any explanation which leaves them with little faith in the diagnosis by doctors, thus eroding the credibility of CGHS. The Committee believes that health care service provider should be tender- hearted towards the ailing patients. He is meant to do away with patients’ pain and not for causing further agony to them. They are dealing with people who are sick, old and helpless. During oral presentations, the Committee noted that one of the reasons behind these behavioral problems may be acute shortage of staff and doctors with no provision of leave reserves. Besides, voluntary Retirement Scheme availed by doctors due to lack of good service conditions in CGHS further add to the existing shortage of staff. 28. In the meeting held on 27th June, 2011, the Department informed about the steps taken to improve the attitude of doctors and staff towards the patients. In order to address this issue the Department informed that it has put in place a mechanism to have surprise inspections in CGHS Wellness Centres in Delhi and outside Delhi by its officers and submissions of reports thereon. The Committee was further apprised that quarterly meetings of these officers are also being held to look into the complaints of the beneficiaries. It was informed that strict instructions have been issued to the in charges of Wellness Centres to pay full attention to the patients’ well being. 29. The Committee takes note of the efforts made by the Ministry to address the issues relating to punctuality and behavioral aspects but feels that still much more need to be done in this regard. The Committee, therefore, recommends that the frequency of surprise inspections should be increased and feedback of the beneficiaries gathered regularly. The Committee also recommends that immediate necessary remedial measures should also be taken on the shortcomings pointed out in the Inspection reports and feedback.
INFRASTRUCTURE 30. The Committee’s attention was also drawn towards the poor infrastructure of the most of the Wellness Centres. The Committee noted that many of the Wellness Centres are functioning in make-shift DDA flats and other such buildings which are not really suited for running such Wellness Centres. Various stakeholders in their written submissions have complained about the crowded Wellness Centres with unsatisfactory sanitary and hygienic conditions. 7
31. With regard to maintenance of sanitary and hygienic conditions of the Wellness Centres, the Department has informed that according to the SIU norms of Department of Expenditure, sanitation and security services are to be outsourced. The concerned zones have already taken steps to outsource the same as per vacancy positions. The Committee, on local study tour to various Centres, was dismayed to note the poor maintenance of buildings and premises by CPWD staff at Noida and Dwarka Wellness Centres. Further, the Sub-Committee noticed that no outsourcing of Grade IV staff has been done at Dwarka wellness centre. The area welfare officer from Ghaziabad Wellness Centre informed the Committee that the wellness centre is located in 3 storey building without a passenger lift and no funds have been earmarked to CPWD for carrying out maintenance work of these Wellness Centres. The Committee was also apprised of the need for providing air- conditioning facility in the stores and pathological laboratories to protect medicines/medical samples taken. 32. The Committee expresses its anguish over the sorry state of the many of the buildings housing the Wellness Centres which are in dilapidated condition. The Committee also notes that in many centres there is inadequate space, seating arrangement and facility of drinking water. One of the parameters judging the success of any health care delivery system is the hygiene it maintains and availability of basic amenities like water, electricity to support proper infrastructure. The Committee feels that the unhygienic environment, improper sanitation in Wellness Centres would erode the credibility of the healthcare services. The Committee, therefore, recommends that the Ministry should understand the exigency of proper infrastructure and cleaning staff in CGHS Wellness Centres all over the country as a pre-requisite to provide the health facilities for the beneficiaries. The Committee has also noted that the Ministry has outsourced the cleaning work to a private agency which is handling the mechanized cleaning for the last one year. The Committee desires that the work of private agencies handling cleaning work under CGHS should be frequently monitored. 33. The Committee observes with concern that basic infrastructure like ECG machine, Glucometre etc. are not available in the Wellness Centres. The Committee recommends that such basic medical instruments should be made available in all Wellness Centres.
PROBLEMS FACED BY SENIOR CITIZENS 34. The Committee was apprised of the sorry state of treatment being meted out to elderly beneficiaries who virtually have to struggle to see the doctors and get medicines at the CGHS Wellness Centres. Some of the elderly beneficiaries informed the Committee that in the absence of proper mechanism and shortage of staff and doctors they often have to wait for long hours to see the doctors. To further add to their woes is the long wait at the pharmacy counters. The situation gets worse if the prescribed medicines are not in stock and are indented and they have to again come to the Wellness Centres for collecting the medicines. In case they purchase their medicines from authorized chemist outside the Wellness Centres, getting bills reimbursed is another ordeal for them. 35. The Department has accepted the fact that despite repeated instructions regarding giving out of turn treatment to senior citizen/pensioners and service at each activity level, this system is generally not being enforced at the wellness centre level. The Department has informed that the CMOs in- charge of the Wellness Centres have been instructed to personally make rounds of the wellness centre particularly during peak hours to ensure that senior citizens are being treated promptly in compliance with the instructions given by the Department. 36. It was brought to the notice of the Committee by several beneficiaries that at geriatric Wellness Centres, doctors are not punctual resulting in lots of hardship for the senior citizens. The 8
Committee has also found that specialty services are deficient at most of the Centres. In addition, Committee was surprised to find the absence of vital services like cardiology & neurology in these Centres which are sine-qua-non for senior citizens. 37. During the study visit by Sub-Committee at Noida CGHS Wellness centre, the CMO in- charge informed that the centre has started a special scheme for senior citizens where patients above 85 years are visited by doctors once in 3 months to enquire about their well being. The Committee has received suggestions for providing similar services in other Wellness Centres across the country. The Committee suggests that the Department should consider the matter and take necessary measures to provide domiciliary services for the senior citizens in all Wellness Centres. The Committee also impresses upon the Department to ensure that the instructions issued by it for paying special attention to senior citizens/pensioners are implemented in letter and spirit and strict compliance of the instructions along with devising a system for fixing responsibility for noncompliance thereof must be ensured without further delay. If need be, a ‘Committee for Senior Citizens’ can be constituted at every Wellness centre which would ensure compliance of the relevant instructions. In addition to this, the Committee suggests that geriatric sensitization should be ingrained in the minds of doctors and staff in Wellness Centres. It also recommends for appointing Geriatric specialist doctors for the elderly CGHS beneficiaries who may visit various CGHS wellness Centres on designated dates. The Committee also impresses upon the Department to further strengthen the CGHS facilities available in Government Hospitals/Private Hospitals empanelled under CGHS to ensure hasslefree treatment for beneficiaries.
SHIFT SYSTEM AT CGHS WELLNESS CENTRES 38. The Committee in its 39th Report on Demands for Grants 2010-11, had emphasized on the need for introduction of shift system in CGHS Wellness Centres. According to the feedback given to the Committee, the Ministry has stated that two shift system at CGHS Wellness Centres has been introduced in Noida, Gurgaon and Faridabad from August, 2011. However, response to this new initiative is not encouraging. 39. During the Committee’s visit to Noida wellness centre, the CMO informed that their centre had started afternoon shift w.e.f. 15th June, 2011 and an average of 50 patients daily utilize the evening services. 40. The Committee appreciates the Ministry’s efforts in starting double shift system in some of the Wellness Centres and proposes that feasibility of introducing double shift system in other Wellness Centres in Delhi be explored so that beneficiaries need not have to take leave from their offices to consult the doctors in morning hours. Further, patients’ load in morning hours at Wellness Centres would also get evenly distributed. As regards the tepid response to the second shift, the Committee recommends that to increase the patient inflow in evening shift in the Wellness Centres, wide publicity may be given through local newspapers and official website of CGHS and other print and electronic media channels. To address the issues relating to availability of staff and doctors for evening shift, the Committee proposes that their services can be utilized on rotation basis. The Committee is of the firm view that these efforts would certainly strengthen the scheme.
EMERGENCY SERVICES 41. The Committee has received numerous requests from experts and stakeholders to restart the emergency services at Wellness Centres as was available earlier in many dispensaries. It has also been requested that one doctor should be on duty at night at the CGHS Wellness Centres for dealing with the emergency cases. 9
42. The Committee was apprised that the reason behind the gradual closing of emergency shifts was low patients’ attendance resulting in underutilization of the manpower and resources. Also, in case of medical emergencies, the beneficiaries may go to any hospital for treatment and claim the reimbursement as per the package rates. At present, there are only 6 Wellness Centres where emergency services are in operation. 43. The Ministry has also submitted that all CGHS Wellness Centres provide emergency medical facilities to its beneficiaries during working hours from 8.00 A.M. to 3.00 P.M. In addition, emergency medical facilities are also provided between 3.00 P.M. to 8.00 A.M. at six CGHS Wellness Centres/hospitals namely – North Avenue, South Avenue, Telegraph Lane, Pandara Road, Kingsway Camp and Timarpur. CGHS beneficiaries may go to any hospital whether empanelled or not in case of medical emergencies. 44. The Committee is of the view that Emergency services are meant to stabilize a suffering patient by providing initial treatment so that he gets time to reach the hospital for further management. If a patient gets emergency first aid at the wellness centre only, then he can be shifted to hospital in a given time. The Committee impresses upon the Ministry to explore the possibility of starting evening and the emergency services at all these Wellness Centres depending upon the number of the beneficiaries catered by the Centres. The Committee suggests that the services of the CGHS Wellness Centres should be made available round the clock on 24 hour basis on the lines of hospitals. There should be at least one doctor available at the wellness centre at all times. The staff can be appointed to work in shifts on rotation basis. Initially the scheme to introduce emergency services in CGHS Wellness Centres on round the clock basis can be started as pilot project in a few Wellness Centres and based on the feedback received from them, the scheme can be extended throughout the country. 45. The Committee was of the opinion that all the emergency units of CGHS should have ambulance service to attend to. The Committee, accordingly, recommends each emergency unit of CGHS should be equipped with ambulance service. 46. Further, the Committee also feels that the suggestion of opening mini-casualty centre for every 6-8 Wellness Centres to offload the hospital casuality wards as submitted by some of the witnesses may also be considered by the Department. 47. The Committee is also of the opinion that a Control Room/ Call Centre should be set up to provide important information to the beneficiaries in dire need of emergency treatment.
AYURVEDA, YOGA CENTRES 48. The Committee was informed that at present, there are 86 AYUSH Wellness Centres/units and 4 Yoga Centres rendering their services under CGHS. During the local study visit, the Committee was informed that Ayurveda centres and yoga clinics have also been opened at Noida and Ghaziabad Wellness Centres. The Committee appreciates the Ministry’s efforts in co- locating Ayurvedic and Yoga therapies with the allopathic system of medicine at CGHS Wellness Centres. The Committee, however, observes that a lot more is still required to be done for giving due thrust and place to these alternative therapies. The Committee also takes note of the shortage of Ayurvedic doctors and yoga trainers in many of the CGHS Wellness Centres and exhorts the Ministry to take required action to fill up the existing vacancies in a time bound manner. The Committee also suggests that steps may be initiated to extend yoga and Ayurvedic systems of therapies to other CGHS Wellness Centres as well. 10
HOMOEOPATHY AND UNANI CENTRES 49. In the meeting held on 11th October, 2011, the Committee heard views of Dr. Prakashan, Vice-president-All India Homoeopathic Doctors Association on the current status of availability of Homoeopathic system of treatment in CGHS Wellness Centres. He informed that in Delhi there are 13 Homoeopathic Centres out of which 3 are Homoeopathic Wellness Centres and 10 are homoeopathic units. The homoeopathic units were started with a view to convert them into full fledged Wellness Centres. The States like MP, Orissa, Uttarakhand, etc., are exempted from setting up of Homoeopathic Wellness Centres. He also informed that the administrative control of the homoeopathic units remains with the in-charge of allopathic dispensary who is not suitably qualified to judge the performance of homoeopathy doctors. He also highlighted that there is only one post for the pharmacist from Homoeopathic system and when he is on leave it leads to difficulties in dispensation of medicines. He, further, highlighted the issues of giving Non Functional Selection Grade (NFSG) to Homoeopathic doctors; training of Medical Officers from Wellness Centres who are posted as in-charge of a medical store depots and urgent requirement of establishment of Homoeopathy Wellness Centres in the areas like Paschim Vihar, Dwarka, Rohini, Gurgaon and Faridabad. Many beneficiaries have also requested to start homoeopathic services at their respective Wellness Centres. 50. The Committee is of the view that homoeopathy is widely popular because of no or minimal side effects. The Committee, therefore, is of the opinion that the Ministry should strive towards providing regular homoeopathy services at all the Wellness Centres. The Committee also suggests that the Ministry should take necessary steps to address the above problems as highlighted by then Vice-President, All India Homoeopathic Doctors Association. 51. The Committee also heard views of Dr. Talat Usmani, CMO in- charge, Unani dispensary, Sarojini Nagar who informed it that in Delhi, there is only one Unani dispensary, four units and one special unit that is opened for only one day i.e., ‘Tuesday’ in the Medical Centre Parliament House Annexe. As regard the problems currently being faced in running the Unani System of medicine in CGHS Wellness Centres, he apprised that the foremost issue was the delay in purchase of the Unani medicines even after clearance by the higher authorities. According to him, the other aspect which was hampering the progress of Unani system was shortage of staff. He drew attention towards the number of posts for medical officers, pharmacists and grade IV staff that are lying vacant at Delhi and outside Delhi in Unani Wellness Centres. 52. The Committee is of view that the Ministry should look into the matter and take necessary remedial measures to fill up the vacant posts of doctors and other allied staff in Unani Wellness Centres to ensure smooth functioning of the Unani Wellness Centres. The delays reported in procurement of Unani medicines should also be looked into and necessary action be taken.
LOCATIONS OF WELLNESS CENTRES 53. Another aspect which was brought to the notice of the Committee was about the unapproachable location of some of the Wellness Centres/Beneficiaries of the Wellness Centres at Ghaziabad, Dwarka, Noida, Shillong etc. have submitted before the Committee that the existing centres are not centrally located. They are located at remote places and outskirts of the cities. The Wellness centre at Ghaziabad is located at a far away place and not well connected. Public mode of transport was not available for most of these Wellness Centres. Similarly in Shillong the Wellness Centre is located at the outskirts of the city and the beneficiaries are hesitant to visit the centre. 54. The Committee, strongly recommends that all Wellness Centres located at remote or on the outskirts of the city should be shifted to convenient centrally located places at the 11 earliest. State Government/other concerned authorities may be approached to allot/provide plot/premises at convenient and central locations for housing these centres.
PREVENTIVE HEALTH CHECK-UP SCHEME 55. Numerous requests for introducing annual health check-up plans for the beneficiaries above the age group of 40 years have been received by the Committee. The Committee was informed that the Department has already expanded the Preventive Health check up scheme at 8 CGHS Wellness Centres in addition to one already existing at R.K Puram-V (South Zone) from the year 2012 keeping in view the importance of diagnosis of Chronic Noncommunicable health problems at the preventive level. 56. The Committee appreciates the Department’s efforts for starting Preventive Health Check-up Scheme and feels that such schemes would benefit the CGHS in the long run as preventive measures are more economical as compared to the curative measures. Further, the Committee is of the opinion that such services should be made available to all the CGHS beneficiaries and not limited to specified Centres. 57. The Committee also recommends that medical details of patients should also be kept online and made available if required.
DIAGNOSTIC SERVICES 58. The Committee expresses its displeasure with the present condition of the diagnostic services under CGHS. Despite Departments’ claim that only NABL accreditated laboratories are under CGHS empanelment, the Committee has received complaints of substandard and poor quality equipments, lack of basic tests facility, malfunctioning of existing equipments, lack of air- conditioned labs. 59. In the meeting held on 26th July, 2012, the witnesses who appeared before the Committee informed that the lab facilities provided under CGHS are only for blood sugar, TLC & DLC and even these services are not up to the mark. The patients are referred to private pathology labs for rest of the investigations. 60. During the local study visit to some Wellness Centres, the Committee noted that there were no testing facilities at Mayur Vihar Wellness Centre and there were no pathologist & microbiologist at Noida Wellness Centre. The Committee noticed that the instruments for checking Blood pressure, temperature were not even calibrated at Ghaziabad Wellness Centre. 61. The Committee feels that the Department needs to address all the shortcomings existing in the facilities provided at the diagnostic Centres under CGHS. The Committee understands that correct diagnosis is imperative for getting the right treatment. Unless adequate diagnostic and laboratory benchmarks are not only set but also complied with at CGHS Wellness Centres, there will be serious implications for the patients. The Committee, accordingly, suggests that in order to ensure the efficiency of labs and diagnostic Centres, it is imperative that diagnostic Centres and labs are well equipped with state-of-the art technology equipments so as to facilitate quality medical care at CGHS Wellness Centres. The Committee would, therefore, like the Department to initiate action in this regard. Further, the Committee would like to be apprised of the progress made in the process of NABL accreditation of labs and diagnostic centres under CGHS.
SEPARATE WING FOR CGHS BENEFICIARIES 62. Many of the beneficiaries through their oral evidences and also through written 12 representations informed the Committee that CGHS beneficiaries had to face hardships in Government hospitals where no separate facilities have been earmarked for CGHS beneficiaries. It was also mentioned that Dr. Ram Manohar Lohia Hospital has got Orthopaedics and Medicine units in CGHS wing and for rest of the specialties like cardiology, neurology etc. the beneficiaries have to see doctor along with general public which is tiresome especially for senior citizens. 63. The Committee has also been informed that both the Defence and Railways have got exclusive and full fledged hospital facilities for their serving and retired employees. While it may not be possible to have separate hospitals for Central Government employees, provision of separate wing for CGHS employees in Central Government, State Government and District Hospitals may be considered to ensure parity with the facilities being provided to the Defence & Railways employees. 64. The Committee, therefore, recommends that the Department should explore the possibility of opening a separate CGHS wing in all the Government hospitals covering all disciplines of medical facilities to make it more convenient for the CGHS beneficiaries to consult the specialist doctors.
PLASTIC IDENTITY CARDS 65. The Committee has been informed that plastic identity cards are being issued as part of computerization process to all the CGHS beneficiaries so that they can avail the medical facilities in any city should they happen to be in that city either on official work or on leave. With the introduction of plastic cards, beneficiaries can get medicines from any wellness Centre across the country without the need of carrying temporary attachment from their respective offices. The Department has also submitted that for issue of plastic cards, provision of online application has been made. As per the new procedure, applications for CGHS cards for serving employees are received through their administrative offices/departments. CGHS plastic cards are collected from the office of CGHS by a designated officer from the departments/offices. Retiring employees/ beneficiaries have an option to apply for issue of pensioner CGHS cards in advance, 6 weeks before superannuation, so that they get pensioner cards ready at the time of their retirement. 66. During the course of the meeting held on 27th June, 2011, the Committee was apprised that the plastic cards are being issued to the beneficiaries through an outsourcing agency. Further, the Department had informed that out of 10 lakh beneficiaries in Delhi, 8.7 lakh cards have already been prepared and 75% of these cards have been collected. The Department also informed that there have been cases of delay in issuing of plastic cards and the same will be reviewed with the outsourcing agency. However, the inspection report of wellness centre at Dwarka furnished by the Department has highlighted the need to address the issue of distribution system of plastic cards. (Annexure-IV) 67. The Committee has been given to understand that though the plastic card entitles a beneficiary to avail treatment at any CGHS Wellness Centre, this rule is not being implemented on the ground. The Committee, therefore, recommends that the Department should make efforts to ensure that the instructions issued by it regarding plastic cards are followed at all the Wellness Centres across the country. The Department should also look into the reasons for delay in issuing the plastic cards and address the same on priority basis. 68. It has also been brought to the notice of the Committee that unclaimed CGHS plastic cards are being misused in the CGHS Wellness Centres, and medicines procured against these cards are being sold in the open markets. 69. The Committee takes a serious view of such malpractices and impresses upon the Department to take necessary action in this regard. The Department may fix a timeline for 13 collection of the plastic cards by the beneficiary so that the unclaimed cards are surrendered to the issuing authority, if they remain uncollected beyond a specified period of time.
COMPUTERIZATION 70. The Committee is happy to note that computerization has been completed in all CGHS Wellness Centres and is in progress in Ayush Wellness Centres/Units/Medical Store in Delhi and NCR. 71. The Committee however, received numerous oral and written complaints from beneficiaries regarding the inordinate delays they have to face in getting treatment despite computerization in Wellness Centres. The Committee was informed that in case of poor network connectivity, systems don’t work and all the work comes to a halt. The Committee recommends to the Department to look into the causes of this delay and draw concrete action plan to ensure smooth functioning of software and to put in place an efficient mechanism to promptly handle network issues so that the benefits of computerization, can be reaped. 72. The Committee also took note of a few suggestions given by the beneficiaries such as making available health education articles on home page of the CGHS website for educating people about prevention of commonly prevalent diseases and illnesses. Some health related dos and don’ts may be put on the CGHS website and publicity may be given on this at the Wellness Centres. Further, making available the facility of booking prior appointment online for the specialists on the lines of private hospitals was also mooted for the benefit of beneficiaries especially for senior citizens. The Committee recommends that the Department may explore the possibility of utilizing such inputs for making CGHS more people friendly. 73. The Committee also took note of the fact that presently there is no computerized system wherein any empanelled hospital can give the data of all referred cases by the CGHS Wellness centre. Though presently computerized referral letters are being generated for retired employees, computers of CGHS Wellness Centre are not linked to the empanelled Hospitals. The Committee observes that the integration of panel hospitals and Wellness Centres for online transmission of data is yet to be done. The Committee, therefore, recommends that immediate steps be taken to formulate policy in this regard and develop and operationalize appropriate software for the purpose. 74. The Committee is also of the opinion that the Department should take measures for on-line empanelment with tariffs to maximise the utility of computerization of the system and make it more transparent and accessible.
POLYCLINICS 75. The Department has informed that specialized consultation is being provided at the polyclinics and at present four CGHS polyclinics are in operation at Kasturba Nagar I, Pusa Road, Timarpur and Laxmi Nagar; 16 polyclinics are running at other locations outside Delhi. The Committee has received numerous requests from various stakeholders regarding opening of more polyclinics and connecting them to the Wellness Centres so that diagnostic tests reports of the patients can be made available online. 76. Keeping in view the numerous requests received from various stakeholders, the Committee would appreciate if the Department undertakes an urgent review of the polyclinics presently functioning especially with regard to provision of speciality services in 14 these polyclinics and at the same time explore the possibility of opening more polyclinics at other places also so as to ensure good health care to greater number of CGHS beneficiaries.
AUTHORISED MEDICAL ATTENDENT FOR BENEFICIARIES 77. The Committee has been given to understand that the CGHS cardholders are entitled to cashless treatment and diagnostic facilities at CGHS empanelled hospitals/diagnostic centres. However, these facilities are not extended to those who are not covered under a CGHS Dispensary and avail the services of the Authorised Medical Attendent under Central Services (Medical Attendance) Rules. The Committee is of the view that such an arrangement is patently unfair and recommends that cashless benefits both for consultation and diagnostic services be extended to the AMA beneficiaries.
EFFICACY OF EMPANELMENT PROCEDURE
Empanelment of Hospitals 78. As CGHS is spread over 25 cities only, the remote areas are lacking these facilities due to lack of hospitals under empanelment and nonavailability of any CGHS wellness Centre in their area. This leaves the beneficiaries with no choice except going to the State Government hospitals where they have to undergo numerous hardships like long waiting hours to see the doctor and get treated. 79. The Committee heard the views of certain witnesses in order to understand the functional status of the empanelment scheme. In this regard, the Committee in its meeting held on 11th October 2011, was informed that empanelment procedure is complex and the rates offered by CGHS are far lower than the actual rates in private hospital due to which private hospitals are reluctant to get empanelled. The Committee also noted that the reputed multispecialty hospitals like, Apollo, Batra, Rockland, Escorts have withdrawn their empanelment due to delayed bill settlement processes and also that some private empanelled hospitals try to avoid admitting CGHS beneficiaries on the pretext of non-availability of beds. 80. As regards the empanelment procedure and rates the Committee was informed in the meeting held on 27th June 2011, that empanelling process is reviewed every two to three years. The Committee was apprised that in total, there are 246 hospitals under empanelment out of which Delhi has about 100 hospitals, but in NCR like Gurgaon, Faridabad, Noida, Ghaziabad and other cities where very few hospitals and diagnostic Centres have been empanelled, a concept of a continuous empanelling scheme on the same terms and conditions was introduced to get more and more hospitals and diagnostic Centres on CGHS panel in such cities. 81. The Committee was also informed that for empanelment of hospitals, laboratories and imaging Centres under CGHS, they have to be accreditated by NABH, NABL, and AERB respectively to ensure good quality health care services including medical and diagnostics services to CGHS beneficiaries. Keeping in view the continued lack of sufficient hospitals/diagnostic Centres under CGHS panel in Mumbai, Shillong, Trivendrum, Dehradoon, and Guwahati the applications have again been invited from private hospitals and diagnostic laboratories under extended continuous empanelment scheme with some relaxation in respect of NABH accreditation. Hospitals so empanelled under relaxed conditions are provided to give an undertaking to apply for NABH accreditation within six months of empanelment as decided by the Committee of Secretaries. 82. The Committee takes note of the fact that flexibility of allowing empanelment without prior accreditation has been given in view of the lack of sufficient empanelled hospitals in certain cities and strongly recommends that the Department should ensure 15
NABH/NABL accreditation of such hospitals/diagnostic Centres within six months of their empanelment and no further relaxation on this account should be given. 83. As far as rates are concerned, the Committee was informed that only L1 rates are notified & all those hospitals who agree for the notified rates get CGHS approval for empanelment. The Committee would like the Department to do a comparative analysis of the CGHS rates vis-à-vis the rates fixed and paid by the health insurance companies to private hospitals/ diagnostic centres so that a reasoned decision regarding the rates could be arrived at. The Committee is aware that the private hospitals are driven by profit motives and charge exhorbitant rates for treatment and diagnostic procedures and therefore, they should not be allowed to dictate terms in this regard. 84. The Committee, accordingly, recommends framing of a more rational policy for revision of rates. The Committee would also like the Department to ensure that the bills preferred by the private hospitals/diagnostic centres are processed promptly and genuine claims are settled without hassles within a specified time-frame and the empanelled hospitals/diagnostic Centres are not subjected to unnecessary delays in reimbursement of their claims of expenditure. 85. The Committee has been given to understand that some of the CGHS empanelled Hospitals have been refusing admission to the CGHS beneficiaries on the ground that CGHS beds were not available to accommodate them. The Committee takes a serious note of this. The Committee is unable to understand as to how a CGHS empanelled hospital can refuse admission to the CGHS beneficiary merely on the ground that CGHS bed was not available. Any refusal of admission by an empanelled hospital amounts to discrimination towards the CGHS beneficiaries. The Committee, therefore, strongly recommends that the Ministry should look into the matter to find out the reasons for which empanelled hospitals are avoiding treatment of CGHS beneficiaries and take remedial measures so that the CGHS beneficiaries are not put to any such discrimination in the CGHS empanelled hospitals. There should be a mechanism in place to look into such instances. Further, measures should be taken to increase the number of empanelled hospitals. 86. The Committee observes that the beneficiaries in the districts where there is no CGHS dispensary or empanelled Hospitals, face lots of difficulties. The Committee, therefore recommends that there should be atleast one empanelled hospital under CGHS in every district of the country for the service of the beneficiaries and thus save them from unnecessary hassle.
Empanelment of Cancer Hospitals 87. The Committee, in its meeting held on 27th Junes 2011, expressed its concern about shortage of hospitals empanelled for cancer treatment and was apprised that there are ten well known cancer hospitals in Delhi and one in Hyderabad empanelled under CGHS for cancer treatment. Besides,the CGHS beneficiaries can avail treatment from any hospital offering treatment for cancer, even if it is not recognized, subject to the rates prescribed for Delhi. As far as rates are concerned, rates of Tata Memorial hospital for surgical procedures and for radiotherapy and chemotherapy rates prevailing in super specialty hospitals have been finalized. 88. Keeping in mind the number of treatment options available for cancer afflicted patients in private hospitals and the associated treatment cost, the Committee would like to suggest that more hospital with such facilities should be considered for empanelment. The Committee would like to emphasize that the kind of specialized services being offered by a hospital, especially for terminal diseases like cancer, should be the basic criteria for selection of a hospital for empanelment. 16
Insurance scheme for cancer and other terminal diseases 89. The Committee takes note of the fact that prevalence of terminal diseases such as cancer is increasing in the country and their treatment involves huge cost. Though the Central Government employees are covered under CGHS and have the coverage of treatment of cancer and other terminal diseases, but they have to meet huge amount of expenditure out of their pocket. CGHS/Department concerned also incur heavy financial burden on account of these diseases. For ensuring better and timely treatment and for avoiding heavy financial burden on the beneficiaries as well as the Department concerned, the Committee is of the view that there should be a separate insurance policy to cover the entire expenditure involved in the treatment of cancer and other terminal diseases for CGHS beneficiaries. The premium can be shared by the CGHS and the beneficiaries in a ratio that can be decided by the Government. The Committee, therefore, recommends that the Ministry may examine this suggestion seriously and come out with a concrete proposal.
BILL SETTLEMENT 90. For the settlement of medical reimbursement claims of the beneficiaries it was informed that the Department has laid new comprehensive procedure to ensure timely and hassle free disposal of medical reimbursement claims in order to facilitate prompt reimbursement of medical expenses to the pensioner beneficiaries. These initiatives include doing away with the requirement of verification of bills by the treating doctor and essentiality certificate, and issuance of specific guidelines for examination of requests for full reimbursement of claims. Also, the beneficiaries now have the option of submitting the original bills under any health insurance scheme that they may be subscribing and claim the balance amount from CGHS/Department that shall be as per CGHS rates and regulations. CGHS has also laid down guidelines to reimburse the expenses incurred on IVF treatment to CGHS beneficiaries. 91. The Committee takes note of the fact that the CGHS beneficiaries are no longer required to get their medical bills verified by the treating doctor and furnishing of essentiality certificate has also been done away with. However, the Committee has been given to understand that this facility is not available to those Central Government Employees who avail medical facilities under Medical Attendance Rules, 1954. The Committee, therefore, impresses upon the Department to immediately address this issue and extend the same facilities to those covered under M.A. Rules. The Committee also calls upon the Department to issue a fresh circular clarifying the procedures in this regard and dispelling misgivings, if any. 92. The Committee has been informed that in order to expedite the process of bill clearance, the Department has engaged UTI-TSL as Bill Clearing Agency under which the empanelled hospitals and diagnostic Centres are required to submit their bills after discharge of the patient which will pay them the applicable amount as per the package rates for the treatment within 10 days. Further, Committee was given to understand that this scheme is expected to help the pensioners in availing healthcare facilities. The Committee would like the Department to examine the performance of this Scheme and take corrective measures if found short on any account. 93. The Committee’s attention was also drawn towards the hardships the beneficiaries have to face in getting their bills reimbursed which reflect that the Departments initiative to streamline reimbursement of claims have not yet yielded the desired results. 94. The Committee, accordingly, suggests that the Department should once again review the online bill submission and approval process so that the online bills submitted by the hospitals can be approved by the bill clearing agency and then the hospitals should submit the bills as this will minimize the reconciliation/ disputes and reduce bill payment cycle. The 17
Committee also suggests that the department should once again review the reimbursement process and make it simpler and transparent in view of the concerns put forth by the beneficiaries. Besides, the department should ensure that the claim adalats meant for settling pending claims are held regularly. 95. The Committee further recommends that since, one Bill Clearing Agency is not able to clear all the bills in time, the Department should appoint more agencies and specify the time period within which the bills have to be cleared.
EXPANSION OF CGHS 96. During the course of meeting held on 26th July 2011, the Committee was informed that there is shortage of Wellness Centres in various areas. People have to travel long distances to reach the nearest CGHS centre to avail medical facilities. In case of emergencies, due to traffic jams on roads, these situations may prove fatal. 97. In the meeting held on 27th June 2011, the Committee was apprised of the fact that the criteria of opening CGHS dispensary is dependent on the number of beneficiaries i.e. 2000 beneficiaries in existing city and 6000 beneficiaries in new city. The Director (CGHS) further apprised that CGHS is available in 25 cities and there was no proposal to extend it to other cities, as CGHS right now is overstressed. It was also informed that Ministry of Finance has declined the proposal of covering pensioners under CSMA rules and instead proposed the existing Health Insurance Scheme for them which is covering non-CGHS areas with strong network of private hospitals for them. 98. The Committee feels that by merely accepting that there is no room for further expansion does not relieve the Department of its commitment to provide required health care to the existing government employees and former employees. At a time when the avowed objective of the Government is to bridge the gaps in health infrastructure and human resources for health, the Committee is at a loss to understand as to why such a retrograde step has been taken, especially in view of the dismal health infrastructure in the country. The Committee recommends that the Ministry of Health and Family Welfare may take up the matter with Ministry of Finance again for expansion of CGHS. 99. The Committee understands that the Government has its own limitations and CGHS Wellness Centres cannot be opened in every corner of the country. In areas where there is no CGHS Wellness Centre, the nearest hospital/diagnostic centre may be empanelled as per the defined empanelment procedure. 100. The Committee is also of the opinion that the number of CGHS Wellness Centres needs to be commensurate with the number of beneficiaries and geographical spread of the cities. It should reach out to the beneficiaries/cardholders rather than making them to travel long distances. 101. The Committee observes that some Hospitals have set up a plant to manufacture stents, which are very economical. The Committee, suggests that CGHS should tie up with such manufacturers and procure stents at wholesale rates for the use of beneficiaries.
DENTAL SERVICES UNDER EMPANELMENT 102. The Committee takes note of the Department’s effort to outsource the dental services through Public Private Partnership (PPP) mode in 13 selected Wellness Centres in Division A (central and south zone) apart from CGHS empanelled dental Centres/government hospitals and polyclinics where dental treatment services can be availed. The Committee is given to understand 18 that about 93 dental procedures can be availed by the CGHS beneficiaries at designated Wellness Centres on the credit basis for both serving and pensioner CGHS beneficiaries. 103. The Committee would like to suggest that the dental services should be made available in all the Wellness Centres and not just in a few selected Centres in Delhi. The same procedure of outsourcing could be utilized in other Centres so that all the beneficiaries across the country can avail dental facilities. The quality, efficacy and adequacy of dental services should be closely monitored. The Department should ensure that the outsourced dentists are not engaged in commercial exploitation of the facilities being provided by the Government. The Committee impresses upon the Department to have a stringent monitoring mechanism in this regard.
NABH/NABL ACCREDITATION 104. The Committee takes note of the Department’s initiative for ensuring quality service to CGHS beneficiaries by making NABH/NABL accreditation of hospitals and laboratories respectively, as compulsory pre-requisite for CGHS empanelment. The NABL/NABH lay down certain norms and standards to be observed and after inspection they provide accreditation to those who fulfill the said standards. There is no guarantee that once accreditated, the Hospital/diagnostic centre will maintain those standards till the next inspection by NABL/NABH. 105. The Committee, therefore, recommends to the Department to be cautious on this move and take necessary steps to ensure that the quality as per accreditation status of empanelled hospitals and diagnostic labs is maintained.
DRUG PROCUREMENT SYSTEM 106. As regards the system of procurement of drugs in CGHS, the Committee was informed that bulk procurement of generic/proprietary/branded drugs for CGHS Wellness Centres in Delhi-NCR is done through Hospital Service Consultancy Corporation at the rates notified by the Medical Stores Organization (MSO). The drugs are stored in Medical Store Depots (MSDs) which supply these drugs to Wellness Centres in a staggered manner. Outside Delhi, it is done by MSO at the rates notified by it and are distributed by its subordinate offices i.e. General Medical Stores Depots for the cities within their respective areas of operation. Life-saving drugs like anti-cancer drugs, drugs in the case of renal failure/transplantation are procured by MSD directly from the manufacturer at the request of CGHS beneficiary on case to case basis. 107. Besides, to further facilitate availability of drugs to the beneficiaries, CMO in-charge of the Wellness Centres are procuring drugs which are not available in the Wellness Centres/MSD from authorized local chemists. It was further apprised that CGHS Wellness Centres in Delhi have been authorized to place indents for commonly prescribed 272 proprietary/branded medicines as per requirement directly on the manufacturers/distributors on rate contract basis fixed by Medical Stores Depot (on a discount of 25% on MRP). This has resulted in higher beneficiary satisfaction, as more than 90% get the medicines on the same day. This has also resulted in reduced inventories at the level of Medical Stores Depot of CGHS. This schemes has now been extended to CGHS in Mumbai, Kolkata, Nagpur and Chennai. Instructions have also been issued by the CGHS to introduce the same to Patna, Bhubaneshwar, Bengaluru, Pune, Ranchi and Guwahati. 108. The Department has also informed that after computerization of CGHS Wellness Centres, the indented medicines are being made available the next day. The Committee also takes note of the procedures laid down for timely availability of medicines to the beneficiaries but fails to understand as to how the desired benefits are yet not reaching the beneficiaries. The dismal state 19 of availability of medicines was brought to the notice of the Committee by the beneficiaries through written submissions as well as through oral submissions. The Committee was apprised that indenting procedure generally takes longer and very rarely medicines are given on the next day. 109. The Committee feels that the key gap lies in the absence of close and sustained supervision of day to day arrangement for indenting, procurement, storage, and distribution of drugs in Medical Store Depots and within CGHS. For this purpose, the Committee would emphasize that the Department should review the system to streamline and revamp it so as to remove the delay in supply of medicines. 110. The Department also informed that they are planning to make certain identified lifesaving drugs part of the formulary so that they can have rate contract and the stocks will be adequate to be supplied to the beneficiaries on case to case basis. 111. The Committee would like to be apprised of the progress made in achieving the smooth operation of drug procurement system. The Committee is of the view that CMOs of the all the Wellness Centres should ensure that all the medicines listed in the formulary are always available in the dispensary. 112. The Committee noted from the submissions from various stakeholders that beneficiaries are often given a substitute of the prescribed medicine without any explanation and therefore they are forced to purchase their medicines from private shops. The Members raised this issue in the meeting of the Sub-Committee on CGHS held on 27th June, 2012. The Members questioned the efficacy of substitute drugs and enquired about the measures being adopted to warrant safety and efficacy of the substitute drugs. In response thereto, the Sub-Committee was apprised that in case a specialist prescribe a drug to a patient and the same is unavailable in the wellness centre, then another drug with similar salt, if available, in the centre is provided to the patient. It was further added that there is no compromise on the quality of drugs procured under CGHS because whenever drugs are brought, some randomly picked samples thereof are sent for testing to laboratories and only when they are passed by the laboratories, they are procured by CGHS. 113. The Committee however, impresses upon the Department to regularly monitor the quality and efficacy of the drugs supplied to the beneficiaries. 114. The Committee observes with concern that the whole process of buying medicines from empanelled chemists is time consuming and difficult as the number of chemists in panel within the specified radius is very less. The Committee, therefore, recommends that at least three chemists should be included within the specified radius of concerned CGHS Dispensary to make it convenient for the beneficiaries. 115. The Committee has received a number of complaints from the beneficiaries regarding the poor quality of medicines and near expiry date drugs being supplied in the Wellness Centres, the possibility of counterfeit and spurious drugs finding their way to the distribution system of medicines through CGHS, and other Government agencies and also certain unscrupulous elements in the CGHS system siphoning off CGHS supplies for sale through chemists. 116. In view of a large number of complaints regarding the quality aspect of the drugs supplied to the beneficiaries the Committee observes that there is an imperative need for an efficient mechanism of quality assurance of the drugs supplied through CGHS. The quality of the medicines is the bedrock for health care services and if it gets compromised, it will erode the credibility of the whole health care delivery system. The Committee accordingly directs that suitable measures be taken to ensure that only good quality lab tested drugs are supplied to CGHS beneficiaries. 20
MALPRACTICES 117. The Committee’s attention was drawn towards the malpractices in CGHS Wellness Centres wherein unclaimed pensioners’ plastic cards that remain uncollected are being used for procuring medicines to be sold in private markets. Moreover, instances of pilferage and bad prescribing habits of doctors leading to high volume of local purchases have also been reported in the submissions of the beneficiaries. 118. As regards checking the incidents of fraud and corruption in procurement of drugs and pilferage of drugs, the Department has informed that with the computerization of CGHS, details of issue of drugs on previous visits are available and further drugs are prescribed and issued to beneficiaries after verifying such details. It is now possible to monitor the demand, supply and consumption pattern of drugs in CGHS Wellness Centres. Indents are placed online. Any unusual change in such patterns is closely monitored and scrutinized at the level of CMOs in-charge and also at Medical Store Depot. Computerization has brought about transparency and accountability in administration of CGHS. Inventory Management of drugs has also improved with computerization. 119. The Department has also informed that to curb malpractices in supply and pilferage of drugs, a copy of the prescription is kept with the bill where the cost of drugs exceeds Rs.1,000/- and the issue of costly drugs is done from MSD, after the CMO in charge of the Wellness Centre verifies the prescription of the Specialist and utilization certificate of drugs issued earlier. A copy each of the prescription and utilization certificate along with a photocopy of CGHS Token Card is kept in record each time drugs are issued. 120. The Committee takes note of the various steps being taken by the Ministry to curb the pilferage of medicines. However, it feels that there is room for further improvement. The Committee, therefore, recommends that the Ministry should seriously consider the option of setting up the strong surveillance system with emphasis on surprise inspections. 121. The Committee is also of the opinion that the specialists should be made aware of all the medicines listed in the Formulary, so that the specialist could prescribe medicines listed in the Formulary which would ensure cutting down of the quantity of local purchase resulting in cost control. In addition to this, orientation in material management should be provided to the in-charge of the Medical store depots from National Institute of Health and Family Welfare, run by the Ministry of Health and Family Welfare who could supervise & guide the lower staff in store activities. Maintaining proper inventory would help in controlling the length of indent list in the CGHS Wellness Centres.
GRIEVANCE REDRESSAL SYSTEM 122. The Committee has been informed that Local Advisory Committees, consisting of representatives of resident welfare associations; pensioners’ associations; and Area Welfare Officers appointed by the Department of Personnel and Training have been constituted at each dispensary level, which meet at least once in a month, preferably on the second Saturday of the month to attend to grievances of the beneficiaries. A complaint/grievance box and complaint/grievance register are also required to be kept at every dispensary. CGHS has also set up help line wherein any beneficiary can lodge his/her complaint, which is attended to by the concerned authorities and a reply sent in a time-bound manner. Claims adalats are being held annually in Delhi in each zone to settle any pending/outstanding bills of pensioner beneficiaries. All Additional Directors/Joint Directors in CGHS cities outside Delhi have also been directed to hold Claims Adalats. 123. However, the Committee has been informed that the ground realities are not much encouraging and the decisions taken by the dispensary advisory committee aren’t honoured by the administration. Various complaints were brought to the notice of the Committee viz. no replies to 21 written complaints/e-mails were received; the phone lines are disconnected without giving satisfactory answers etc., no complaint boxes available; no encouragement for filing complaints; local authorities refuse to tackle the problems related to policy matters due to lack of authority and funds. 124. The Committee observes that merely taking initiatives for effective functioning of CGHS without making them efficacious will not serve the intended purpose. The Committee, therefore, recommends that wide publicity through local and print media needs to be given in this regard and priority should also be given to making the Grievance Redressal Mechanism efficient and effective. In addition to this, every letter/request should be acknowledged; status of complaints should be posted on CGHS website and also data from DGHS should be reviewed yearly to know the real picture and enable the CGHS to deliver quality healthcare services to the beneficiaries. 125. The Committee would also like the Department to identify the problem areas on the basis of the grievances/complaints received and take appropriate remedial measures accordingly.
COMPARATIVE ANALYSIS Of FACILITIES PROVIDED BY EMPLOYEES STATE INSURANCE CORPORATION, INDIAN RAILWAYS AND ARMED FORCES MEDICAL SERVICES 126. In order to improve and further strengthen the services provided under CGHS, Committee felt it appropriate to have a comparative analysis of facility provided under Employees State Insurance Scheme (ESIC), Indian Railways and Armed Forces Medical Service (AFMS) and accordingly at its meeting held on 9th January, 2013 heard DG, ESIC, Ministry of Labour and Employment, DG, Railway Health Services, Ministry of Railways and DGAFMS, Ministry of Defence. 127. The Committee has been informed that under the Employees State Insurance Scheme, medical care services are also provided through Mobile Dispensaries and Employers Utilization Dispensaries. Under indirect provision, a total of 1380 panel doctors are engaged in providing primary medical services through the indirect system. Under the panel system, the clinics of Registered Medical Practitioners are approved for providing outpatient care. “SUVIDHA SAMAGAM” is also organized in all the offices for redressal of public grievances. Separate service window is provided to all the senior citizens for availing medical facilities viz. registration/ consultation/medicine distribution etc. in hospitals/dispensaries wherever feasible. 128. In case of health services provided by Indian Railways, the Committee has observed that in view of the special operational needs of the organization, Indian Railway Medical Service (IRMS) functions as a single unified cadre delivering all kinds of services including Specialist & Super Specialist care as well. The doctors at zonal hospitals are also engaged in teaching and training of PG students (DNB) trainees for specialist and super specialist courses. 129. The Committee has further observed that the Armed Forces Medical Service (AFMS) provides comprehensive and total primary, secondary and tertiary (super speciality) medical care to the dependent clientele. Over 130 AFMS hospitals, equipped with modern equipment as well as expertise of specialist/super-specialists, based on organisational as well as perceived requirement are spread across the country. Presently the AFMS is providing contemporary, state of art super- speciality care, through designated centres/hospitals, in fields like joint replacement, advanced cardiac care, nephrology, organ transplant, vascular surgery, infertility etc. The Armed Forces Hospitals work on authorized scale of equipments called Medical Equipment (ME) Scale. In addition there is a modernization programme which is planned on annual basis and is called Annual 22
Acquisition Plan (AAP). The Office of DGAFMS maintains a vocabulary of drugs and equipments called PVMS (Priced Vocabulary of Medical Stores) which is periodically updated. In addition, certain drugs which are not commonly used or are under the new introduction are called NIV (Not In Vocabulary). Moreover, a Central Complaint Cell functions under the Addl DGAFMS (HR) at the apex office of the AFMS at the O/o DGAFMS. All complaints/representations received at this office are critically analysed, after obtaining necessary inputs from the three medical directorates and due remedial action is taken in order to address the complaint. 130. In the light of the above, the Committee proposes the following for further strengthening the services provided under CGHS: (i) Mobile Dispensaries should be started at the earliest, for underserved areas. (ii) Special sessions may be organized and special cells may be maintained in all the offices for redressal of public grievances and prompt action should be taken, so that the same is not repeated in future. (iii) Separate service window may be provided to all the senior citizens for availing medical facilities viz. registration/consultation/medicine distribution etc. in hospitals/dispensaries wherever feasible. (iv) To monitor the procurement of drugs, a periodically updated vocabulary of drugs and equipments may be maintained. (v) A framework may be designed to monitor timely modernisation of infrastructure and facilities provided under CGHS. 131. The Committee observes that there are several other government players in the field of providing health services e.g., ESI, AFMS, IRMS etc. The Committee would like the Ministry to explore the possibility of covering all such players including CGHS under one umbrella, as an apex organisation.
SEPARATE SUPER-SPECIALITY HOSPITALS EXCLUSIVELY FOR CGHS BENEFICIARIES 132. Various Union Ministries and Departments have separate set up for providing health care facilities to their employees. Ministries of Railways and Defense have very wide and well- established network of dispensaries, hospitals and super speciality hospitals for their employees all over the country. Similarly, Employees’ State Insurance Corporation (ESIC) has also very wide network of dispensaries, hospitals and super speciality hospitals all over the country. A considerable number of Central Government employees are residing in metro cities particularly in Delhi, Mumbai and Kolkata. All Central Government employees can avail health care facilities from the Government hospitals and some of those hospitals like Dr. Ram Manohar Hospital, Safdarjung Hospital have a separate wing for CGHS beneficiaries in some disciplines. But these hospitals are already overcrowded. It is very difficult and time consuming to avail treatment from these hospitals. Besides, almost all medicines, kits and accessories for surgery etc. are to be purchased by the beneficiaries from the open market for which they can claim reimbursement from their respective departments. 133. Keeping in view the above facts, the Committee strongly recommends that separate super speciality hospitals exclusively for CGHS beneficiaries, on the lines of Ministry of Railways, Defence and ESIC, one each in each metro city, where a considerable number of CGHS beneficiaries are residing along with their families, should be established so that the CGHS beneficiaries can avail super speciality treatment in these hospitals as per their convenience. 23
MEDICAL CENTRE, PARLIAMENT HOUSE ANNEXE 134. The Medical Centre, Parliament House Annexe, was set up to cater up healthcare requirements of the sitting Members and retired Members of Parliament. The above Medical Centre has been providing quality and basic health care facilities including pathological test, x-ray, ultrasound facilities etc. to Members of Parliament, former MPs, Sr. Bureaucrats and Journalists. The Medical Centre has full-fledged physiotherapy unit with all modern gadgets and equipments, pathological lab, x-ray and ultrasound facilities. In addition to services of regular physicians, services of specialist doctors in various disciplines have also been made available at the centre. Most of the sitting Members including Ministers, retired Members are regularly availing health care facilities at the centre and as a result thereof they are not required to go to AIIMS and other Government hospitals, which are already overcrowded, for their day-to-day health care requirements. The Committee has been given to understand that the doctors/staff strength of Medical Centre, PHA has been depleted due to transfer/superannuation of the incumbents to the posts and for which no replacement could be provided so far leading to difficulty in maintaining services to the Hon’ble Members. Most of the equipments are very old and outdated with expired life. Computerization of medical centre is pending for a considerable time whereas all the CGHS Wellness Centres have been computerized. The Medical Centre is also facing shortage of space for accommodating stores, pharmacy etc. There is no provision of leave reserve vacancies for the Medical Centre and in case anyone proceeds on leave, no substitute is made available. 135. The Committee is unable to understand the reasons for which the Medical Centre, PHA has not been computerized so far whereas all the CGHS Wellness Centres have been computerized and are connected with network. The Committee, therefore, feels that the Medical Centre is required to be computerized immediately for keeping check and control on availability/dispensing of medicines and other activities. The Committee strongly recommends that all vacant posts at the Medical Centre, Parliament House Annexe should be filled up immediately. There is need to strengthen the mechanism for provision of replacement of specialists in case of leave. A panel of specialists for replacement duties at the Medical Centre, PHA may be drawn up for this purpose. Old and outdated equipments should be replaced by the latest equipments and gadgets. Keeping in view the utility of physiotherapy unit and the increasing number of patients visiting there, the Physiotherapy Unit of the Centre is required to be expanded further by providing adequate manpower and the latest gadgets and equipments. In order to fill-up vacancies of the supporting staff temporarily till a permanent replacement thereof is provided in different categories, a panel of retired and experienced staff members may be prepared for the purpose. 136. The Committee received a suggestion that a post of PRO should be created for the Medical Centre, PHA. The PRO will provide link between Members of Parliament and various government hospitals including AIIMS, private medical institutions and the specialists and super specialists working there. In case of any specialty and super specialty treatment required by the Members, the PRO will enable them to get appointment with the appropriate specialist/super specialist in the desired medical institutions, both Government and private sector. The Committee recommends the Department to explore the feasibility of appointing a PRO for the convenience of Members of Parliament. 24
RECOMMENDATIONS/OBSERVATIONS — AT A GLANCE
SHORTAGE OF DOCTORS AND STAFF
1. The Committee fails to understand as to why there still exists a huge gap between in-position strength and sanctioned posts of doctors and supporting staff despite the Departments’ claim that the contractual appointments of retired doctors is being made to fill up the vacancies. The fact about this mismatch was brought to the notice of the Committee by the beneficiaries while deposing before it as also during the study visit to some of the Wellness Centres. The same holds true for vacancies in paramedical and other staff also. If all the vacancies had been filled up by contractual appointments as claimed by the Department, the vacancies would have ceased to exist. The Committee is of the opinion that vacancies, irrespective of any category cause overstressing of the existing manpower and directly or indirectly are bound to affect the quality of services rendered to the beneficiaries by the Wellness Centres. CGHS has been established with the vision to cater to health needs of the beneficiaries and shortage of manpower will handicap the successful running of CGHS. The Committee, therefore, recommends that the Department should reassess the strategies adopted to fill up the vacancies and come up with realistic measures so that the shortage of doctors and paramedical staff in CGHS Wellness Centres can be overcome. Efforts should also be made to increase the availability of specialist doctors or consultants in various fields at these Wellness Centres keeping a mind the alarming increase in the number of patients suffering from high blood pressure, diabetes, and other critical illnesses. Adequate provision for leave reserve vacancies for all posts should be made so that substitutes could be provided in case of any one proceeding on leave. (Para 23)
2. The Committee recommends that vigorous efforts should be made by the Department for filling up of all the existing vacancies of GDMOs and specialists and other paramedical staff. The Committee also recommends that adequate provision of leave reserve should be made for doctors and other assisting staff so that the beneficiaries do not have to suffer due to absence of doctors and other assisting staff. (Para 24)
PUNCTUALITY
3. The Committee conveys its anguish at the absence of work discipline in the discharge of duties by the doctors and other supporting staff in the Wellness Centres. The complaints from various stakeholders imply that due to lack of punctuality on the part of doctors and paramedical staff, the beneficiaries have to wait for hours for getting registered and examined. Through written as well as the oral representations, suggestions of undertaking surprise visit to check the punctuality of the staff members by the concerned authorities and introduction of biometric system of attendance have been given by various experts and stakeholders. The Committee, therefore, emphasizes that the above mentioned measures must be introduced to abate this problem of late comers. Besides, period of tea/lunch breaks should be restricted and notified on the Notice Board in the Wellness Centres so that the beneficiaries do not have to wait for longer period. (Para 26)
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BEHAVIOURAL ISSUES 4. The Committee takes note of the efforts made by the Ministry to address the issues relating to punctuality and behavioral aspects but feels that still much more need to be done in this regard. The Committee, therefore, recommends that the frequency of surprise inspections should be increased and feedback of the beneficiaries gathered regularly. The Committee also recommends that immediate necessary remedial measures should also be taken on the shortcomings pointed out in the Inspection reports and feedback. (Para 29)
INFRASTRUCTURE 5. The Committee expresses its anguish over the sorry state of the many of the buildings housing the Wellness Centres which are in dilapidated condition. The Committee also notes that in many centres there is inadequate space, seating arrangement and facility of drinking water. One of the parameters judging the success of any health care delivery system is the hygiene it maintains and availability of basic amenities like water, electricity to support proper infrastructure. The Committee feels that the unhygienic environment, improper sanitation in Wellness Centres would erode the credibility of the healthcare services. The Committee, therefore, recommends that the Ministry should understand the exigency of proper infrastructure and cleaning staff in CGHS Wellness Centres all over the country as a pre-requisite to provide the health facilities for the beneficiaries. The Committee has also noted that the Ministry has outsourced the cleaning work to a private agency which is handling the mechanized cleaning for the last one year. The Committee desires that the work of private agencies handling cleaning work under CGHS should be frequently monitored. (Para 32) 6. The Committee observes with concern that basic infrastructure like ECG machine, Glucometre etc. are not available in the Wellness Centres. The Committee recommends that such basic medical instruments should be made available in all Wellness Centres. (Para 33)
PROBLEMS FACED BY SENIOR CITIZENS 7. The Committee suggests that the Department should consider the matter and take necessary measures to provide domiciliary services for the senior citizens in all Wellness Centres. The Committee also impresses upon the Department to ensure that the instructions issued by it for paying special attention to senior citizens / pensioners are implemented in letter and spirit and strict compliance of the instructions along with devising a system for fixing responsibility for non-compliance thereof must be ensured without further delay. If need be, a ‘Committee for Senior Citizens’ can be constituted at every Wellness Centre which would ensure compliance of the relevant instructions. In addition to this, the Committee suggests that geriatric sensitization should be ingrained in the minds of doctors and staff in Wellness Centres. It also recommends for appointing Geriatric specialist doctors for the elderly CGHS beneficiaries who may visit various CGHS wellness Centres on designated dates. The Committee also impresses upon the Department to further strengthen the CGHS facilities available in Government Hospitals/Private Hospitals empanelled under CGHS to ensure hasslefree treatment for beneficiaries. (Para 37)
SHIFT SYSTEM AT CGHS WELLNESS CENTRES 8. The Committee appreciates the Ministry’s efforts in starting double shift system in 26 some of the Wellness Centres and proposes that feasibility of introducing double shift system in other Wellness Centres in Delhi be explored so that beneficiaries need not have to take leave from their offices to consult the doctors in morning hours. Further, patients’ load in morning hours at Wellness Centres would also get evenly distributed. As regards the tepid response to the second shift, the Committee recommends that to increase the patient inflow in evening shift in the Wellness Centres, wide publicity may be given through local newspapers and official website of CGHS and other print and electronic media channels. To address the issues relating to availability of staff and doctors for evening shift, the Committee proposes that their services can be utilized on rotation basis. The Committee is of the firm view that these efforts would certainly strengthen the scheme. (Para 40)
EMERGENCY SERVICES 9. The Committee is of the view that Emergency services are meant to stabilize a suffering patient by providing initial treatment so that he gets time to reach the hospital for further management. If a patient gets emergency first aid at the wellness centre only, then he can be shifted to hospital in a given time. The Committee impresses upon the Ministry to explore the possibility of starting evening and the emergency services at all these Wellness Centres depending upon the number of the beneficiaries catered by the Centres. The Committee suggests that the services of the CGHS Wellness Centres should be made available round the clock on 24 hour basis on the lines of hospitals. There should be at least one doctor available at the wellness centre at all times. The staff can be appointed to work in shifts on rotation basis. Initially the scheme to introduce emergency services in CGHS Wellness Centres on round the clock basis can be started as pilot project in a few Wellness Centres and based on the feedback received from them, the scheme can be extended throughout the country. (Para 44) 10. The Committee was of the opinion that all the emergency units of CGHS should have ambulance service to attend to. The Committee, accordingly, recommends each emergency unit of CGHS should be equipped with ambulance service. (Para 45 ) 11. Further, the Committee also feels that the suggestion of opening mini-casualty centre for every 6-8 Wellness Centres to offload the hospital casuality wards as submitted by some of the witnesses may also be considered by the Department. (Para 46) 12. The Committee is also of the opinion that a Control Room/Call Centre should be set up to provide important information to the beneficiaries in dire need of emergency treatment. (Para 47)
AYURVEDA, YOGA CENTRES 13. The Committee appreciates the Ministry’s efforts in co-locating Ayurvedic and Yoga therapies with the allopathic system of medicine at CGHS Wellness Centres. The Committee, however, observes that a lot more is still required to be done for giving due thrust and place to these alternative therapies. The Committee also takes note of the shortage of Ayurvedic doctors and yoga trainers in many of the CGHS Wellness Centres and exhorts the Ministry to take required action to fill up the existing vacancies in a time bound manner. The Committee also suggests that steps may be initiated to extend yoga and Ayurvedic systems of therapies to other CGHS Wellness Centres as well. (Para 48)
HOMEOPATHY AND UNANI CENTRES 14. The Committee is of the view that homoeopathy is widely popular because of no or 27 minimal side effects. The Committee, therefore, is of the opinion that the Ministry should strive towards providing regular homoeopathy services at all the Wellness Centres. The Committee also suggests that the Ministry should take necessary steps to address the above problems as highlighted by then Vice-President, All India Homoeopathic Doctors Association. (Para 50) 15. The Committee is of view that the Ministry should look into the matter and take necessary remedial measures to fill up the vacant posts of doctors and other allied staff in Unani Wellness Centres to ensure smooth functioning of the Unani Wellness Centres. The delays reported in procurement of Unani medicines should also be looked into and necessary action be taken. (Para 52)
LOCATIONS OF WELLNESS CENTRES 16. The Committee, strongly recommends that all Wellness Centres located at remote or on the outskirts of the city should be shifted to convenient centrally located places at the earliest. State Government/other concerned authorities may be approached to allot/provide plot/premises at convenient and central locations for housing these centres. (Para 54)
PREVENTIVE HEALTH CHECK-UP SCHEME 17. The Committee appreciates the Department’s efforts for starting Preventive Health Check-up Scheme and feels that such schemes would benefit the CGHS in the long run as preventive measures are more economical as compared to the curative measures. Further, the Committee is of the opinion that such services should be made available to all the CGHS beneficiaries and not limited to specified Centres. (Para 56) 18. The Committee also recommends that medical details of patients should also be kept online and made available if required. (Para 57)
DIAGNOSTIC SERVICES 19. The Committee feels that the Department needs to address all the shortcomings existing in the facilities provided at the diagnostic Centres under CGHS. The Committee understands that correct diagnosis is imperative for getting the right treatment. Unless adequate diagnostic and laboratory benchmarks are not only set but also complied with at CGHS Wellness Centres, there will be serious implications for the patients. The Committee, accordingly, suggests that in order to ensure the efficiency of labs and diagnostic Centres, it is imperative that diagnostic Centres and labs are well equipped with state-of-the art technology equipments so as to facilitate quality medical care at CGHS Wellness Centres. The Committee would, therefore, like the Department to initiate action in this regard. Further, the Committee would like to be apprised of the progress made in the process of NABL accreditation of labs and diagnostic centres under CGHS. (Para 61)
SEPARATE WING FOR CGHS BENEFICIARIES 20. The Committee, therefore, recommends that the Department should explore the possibility of opening a separate CGHS wing in all the Government hospitals covering all disciplines of medical facilities to make it more convenient for the CGHS beneficiaries to consult the specialist doctors. (Para 64)
PLASTIC IDENTITY CARDS 21. The Committee has been given to understand that though the plastic card entitles a 28 beneficiary to avail treatment at any CGHS Wellness Centre, this rule is not being implemented on the ground. The Committee, therefore, recommends that the Department should make efforts to ensure that the instructions issued by it regarding plastic cards are followed at all the Wellness Centres across the country. The Department should also look into the reasons for delay in issuing the plastic cards and address the same on priority basis. (Para 67) 22. The Committee takes a serious view of such malpractices and impresses upon the Department to take necessary action in this regard. The Department may fix a timeline for collection of the plastic cards by the beneficiary so that the unclaimed cards are surrendered to the issuing authority, if they remain uncollected beyond a specified period of time. (Para 69)
COMPUTERIZATION 23. The Committee recommends to the Department to look into the causes of this delay and draw concrete action plan to ensure smooth functioning of software and to put in place an efficient mechanism to promptly handle network issues so that the benefits of computerization, can be reaped. (Para 71) 24. The Committee also took note of a few suggestions given by the beneficiaries such as making available health education articles on home page of the CGHS website for educating people about prevention of commonly prevalent diseases and illnesses. Some health related dos and don’ts may be put on the CGHS website and publicity may be given on this at the Wellness Centres. Further, making available the facility of booking prior appointment online for the specialists on the lines of private hospitals was also mooted for the benefit of beneficiaries especially for senior citizens. The Committee recommends that the Department may explore the possibility of utilizing such inputs for making CGHS more people friendly. (Para 72) 25. The Committee observes that the integration of panel hospitals and Wellness Centres for online transmission of data is yet to be done. The Committee, therefore, recommends that immediate steps be taken to formulate policy in this regard and develop and operationalize appropriate software for the purpose. (Para 73) 26. The Committee is also of the opinion that the Department should take measures for on-line empanelment with tariffs to maximise the utility of computerization of the system and make it more transparent and accessible. (Para 74)
POLYCLINICS 27. Keeping in view the numerous requests received from various stakeholders, the Committee would appreciate if the Department undertakes an urgent review of the polyclinics presently functioning especially with regard to provision of speciality services in these polyclinics and at the same time explore the possibility of opening more polyclinics at other places also so as to ensure good health care to greater number of CGHS beneficiaries. (Para 76)
AUTHORISED MEDICAL ATTENDENT FOR BENEFICIARIES 28. The Committee has been given to understand that the CGHS cardholders are entitled to cashless treatment and diagnostic facilities at CGHS empanelled hospitals/ diagnostic centres. However, these facilities are not extended to those who are not covered under a 29
CGHS Dispensary and avail the services of the Authorised Medical Attendent under Central Services (Medical Attendance) Rules. The Committee is of the view that such an arrangement is patently unfair and recommends that cashless benefits both for consultation and diagnostic services be extended to the AMA beneficiaries. (Para 77)
EFFICACY OF EMPANELMENT PROCEDURE
Empanelment of Hospitals 29. The Committee takes note of the fact that flexibility of allowing empanelment without prior accreditation has been given in view of the lack of sufficient empanelled hospitals in certain cities and strongly recommends that the Department should ensure NABH/NABL accreditation of such hospitals/diagnostic Centres within six months of their empanelment and no further relaxation on this account should be given. (Para 82) 30. The Committee would like the Department to do a comparative analysis of the CGHS rates vis-à-vis the rates fixed and paid by the health insurance companies to private hospitals/ diagnostic centres so that a reasoned decision regarding the rates could be arrived at. The Committee is aware that the private hospitals are driven by profit motives and charge exhorbitant rates for treatment and diagnostic procedures and therefore, they should not be allowed to dictate terms in this regard. (Para 83 ) 31. The Committee, accordingly, recommends framing of a more rational policy for revision of rates. The Committee would also like the Department to ensure that the bills preferred by the private hospitals/ diagnostic centres are processed promptly and genuine claims are settled without hassles within a specified time-frame and the empanelled hospitals/ diagnostic Centres are not subjected to unnecessary delays in reimbursement of their claims of expenditure. (Para 84 ) 32. The Committee has been given to understand that some of the CGHS empanelled Hospitals have been refusing admission to the CGHS beneficiaries on the ground that CGHS beds were not available to accommodate them. The Committee takes a serious note of this. The Committee is unable to understand as to how a CGHS empanelled hospital can refuse admission to the CGHS beneficiary merely on the ground that CGHS bed was not available. Any refusal of admission by an empanelled hospital amounts to discrimination towards the CGHS beneficiaries. The Committee, therefore, strongly recommends that the Ministry should look into the matter to find out the reasons for which empanelled hospitals are avoiding treatment of CGHS beneficiaries and take remedial measures so that the CGHS beneficiaries are not put to any such discrimination in the CGHS empanelled hospitals. There should be a mechanism in place to look into such instances. Further, measures should be taken to increase the number of empanelled hospitals. (Para 85) 33. The Committee observes that the beneficiaries in the districts where there is no CGHS dispensary or empanelled Hospitals, face lots of difficulties. The Committee, therefore recommends that there should be atleast one empanelled hospital under CGHS in every district of the country for the service of the beneficiaries and thus save them from unnecessary hassle. (Para 86)
Empanelment of Cancer Hospitals 34. Keeping in mind the number of treatment options available for cancer afflicted patients in private hospitals and the associated treatment cost, the Committee would like to suggest that more hospital with such facilities should be considered for empanelment. 30
The Committee would like to emphasize that the kind of specialized services being offered by a hospital, especially for terminal diseases like cancer, should be the basic criteria for selection of a hospital for empanelment. (Para 88)
Insurance scheme for cancer and other terminal diseases 35. The Committee takes note of the fact that prevalence of terminal diseases such as cancer is increasing in the country and their treatment involves huge cost. Though the Central Government employees are covered under CGHS and have the coverage of treatment of cancer and other terminal diseases, but they have to meet huge amount of expenditure out of their pocket. CGHS/Department concerned also incur heavy financial burden on account of these diseases. For ensuring better and timely treatment and for avoiding heavy financial burden on the beneficiaries as well as the Department concerned, the Committee is of the view that there should be a separate insurance policy to cover the entire expenditure involved in the treatment of cancer and other terminal diseases for CGHS beneficiaries. The premium can be shared by the CGHS and the beneficiaries in a ratio that can be decided by the Government. The Committee, therefore, recommends that the Ministry may examine this suggestion seriously and come out with a concrete proposal. (Para 89)
BILL SETTLEMENT 36. The Committee, therefore, impresses upon the Department to immediately address this issue and extend the same facilities to those covered under M.A. Rules. The Committee also calls upon the Department to issue a fresh circular clarifying the procedures in this regard and dispelling misgivings, if any. (Para 91) 37. The Committee, accordingly, suggests that the Department should once again review the online bill submission and approval process so that the online bills submitted by the hospitals can be approved by the bill clearing agency and then the hospitals should submit the bills as this will minimize the reconciliation/disputes and reduce bill payment cycle. The Committee also suggests that the department should once again review the reimbursement process and make it simpler and transparent in view of the concerns put forth by the beneficiaries. Besides, the department should ensure that the claim adalats meant for settling pending claims are held regularly. (Para 94) 38. The Committee further recommends that since, one Bill Clearing Agency is not able to clear all the bills in time, the Department should appoint more agencies and specify the time period within which the bills have to be cleared. (Para 95)
EXPANSION OF CGHS 39. The Committee feels that by merely accepting that there is no room for further expansion does not relieve the Department of its commitment to provide required health care to the existing government employees and former employees. At a time when the avowed objective of the Government is to bridge the gaps in health infrastructure and human resources for health, the Committee is at a loss to understand as to why such a retrograde step has been taken, especially in view of the dismal health infrastructure in the country. The Committee recommends that the Ministry of Health and Family Welfare may take up the matter with Ministry of Finance again for expansion of CGHS. (Para 98) 40. The Committee understands that the government has its own limitations and CGHS Wellness Centres cannot be opened in every corner of the country. In areas where there 31 is no CGHS Wellness Centre, the nearest hospital/diagnostic centre may be empanelled as per the defined empanelment procedure. (Para 99) 41. The Committee is also of the opinion that the number of CGHS Wellness Centres needs to be commensurate with the number of beneficiaries and geographical spread of the cities. It should reach out to the beneficiaries/cardholders rather than making them to travel long distances. (Para 100) 42. The Committee observes that some Hospitals have set up a plant to manufacture stents, which are very economical. The Committee, suggests that CGHS should tie up with such manufacturers and procure stents at wholesale rates for the use of beneficiaries. (Para 101)
DENTAL SERVICES UNDER EMPANELMENT 43. The Committee would like to suggest that the dental services should be made available in all the Wellness Centres and not just in a few selected Centres in Delhi. The same procedure of outsourcing could be utilized in other Centres so that all the beneficiaries across the country can avail dental facilities. The quality, efficacy and adequacy of dental services should be closely monitored. The Department should ensure that the outsourced dentists are not engaged in commercial exploitation of the facilities being provided by the Government. The Committee impresses upon the Department to have a stringent monitoring mechanism in this regard. (Para 103)
NABH/NABL ACCREDITATION 44. The Committee, therefore, recommends to the Department to be cautious on this move and take necessary steps to ensure that the quality as per accreditation status of empanelled hospitals and diagnostic labs is maintained. (Para 105)
DRUG PROCUREMENT SYSTEM 45. The Committee feels that the key gap lies in the absence of close and sustained supervision of day to day arrangement for indenting, procurement, storage, and distribution of drugs in Medical Store Depots and within CGHS. For this purpose, the Committee would emphasize that the Department should review the system to streamline and revamp it so as to remove the delay in supply of medicines. (Para 109) 46. The Committee would like to be apprised of the progress made in achieving the smooth operation of drug procurement system. The Committee is of the view that CMOs of the all the Wellness Centres should ensure that all the medicines listed in the formulary are always available in the dispensary. (Para 111) 47. The Committee however, impresses upon the Department to regularly monitor the quality and efficacy of the drugs supplied to the beneficiaries. (Para 113) 48. The Committee observes with concern that the whole process of buying medicines from empanelled chemists is time consuming and difficult as the number of chemists in panel within the specified radius is very less. The Committee, therefore, recommends that at least three chemists should be included within the specified radius of concerned CGHS Dispensary to make it convenient for the beneficiaries. (Para 114) 49. In view of a large number of complaints regarding the quality aspect of the drugs supplied to the beneficiaries the Committee observes that there is an imperative need for 32 an efficient mechanism of quality assurance of the drugs supplied through CGHS. The quality of the medicines is the bedrock for health care services and if it gets compromised, it will erode the credibility of the whole health care delivery system. The Committee accordingly directs that suitable measures be taken to ensure that only good quality lab tested drugs are supplied to CGHS beneficiaries. (Para 116)
MALPRACTICES 50. The Committee, therefore, recommends that the Ministry should seriously consider the option of setting up the strong surveillance system with emphasis on surprise inspections. (Para 120) 51. The Committee is also of the opinion that the specialists should be made aware of all the medicines listed in the Formulary, so that the specialist could prescribe medicines listed in the Formulary which would ensure cutting down of the quantity of local purchase resulting in cost control. In addition to this, orientation in material management should be provided to the in-charge of the Medical store depots from National Institute of Health and Family Welfare, run by the Ministry of Health and Family Welfare who could supervise and guide the lower staff in store activities. Maintaining proper inventory would help in controlling the length of indent list in the CGHS Wellness Centres. (Para 121)
GRIEVANCE REDRESSAL SYSTEM 52. The Committee observes that merely taking initiatives for effective functioning of CGHS without making them efficacious will not serve the intended purpose. The Committee, therefore, recommends that wide publicity through local and print media needs to be given in this regard and priority should also be given to making the Grievance Redressal Mechanism efficient and effective. In addition to this, every letter/request should be acknowledged; status of complaints should be posted on CGHS website and also data from CGHS should be reviewed yearly to know the real picture and enable the CGHS to deliver quality healthcare services to the beneficiaries. (Para 124) 53. The Committee would also like the Department to identify the problem areas on the basis of the grievances/complaints received and take appropriate remedial measures accordingly. (Para 125)
COMPARATIVE ANALYSIS Of FACILITIES PROVIDED BY EMPLOYEES STATE INSURANCE CORPORATION, INDIAN RAILWAYS AND ARMED FORCES MEDICAL SERVICES 54. In order to improve and further strengthen the services provided under CGHS, Committee felt it appropriate to have a comparative analysis of facility provided under Employees State Insurance Scheme (ESIC), Indian Railways and Armed Forces Medical Service (AFMS) and accordingly at its meeting held on 9th January, 2013 heard DG, ESIC, Ministry of Labour and Employment, DG, Railway Health Services, Ministry of Railways and DGAFMS, Ministry of Defence. (Para 126) 55. The Committee has been informed that under the Employees State Insurance Scheme, medical care services are also provided through Mobile Dispensaries and Employers Utilization Dispensaries. Under indirect provision, a total of 1380 panel doctors are engaged in providing primary medical services through the indirect system. Under the panel system, the clinics of Registered Medical Practitioners are approved for providing outpatient care. “SUVIDHA SAMAGAM” is also organized in all the offices for redressal of public grievances. Separate service 33 window is provided to all the senior citizens for availing medical facilities viz. registration/ consultation/medicine distribution etc. in hospitals/dispensaries wherever feasible. (Para 127) 56. In case of health services provided by Indian Railways, the Committee has observed that in view of the special operational needs of the organization, Indian Railway Medical Service (IRMS) functions as a single unified cadre delivering all kinds of services including Specialist and Super Specialist care as well. The doctors at zonal hospitals are also engaged in teaching and training of PG students (DNB) trainees for specialist and super specialist courses. (Para 128) 57. The Committee has further observed that the Armed Forces Medical Service (AFMS) provides comprehensive and total primary, secondary and tertiary (super speciality) medical care to the dependent clientele. Over 130 AFMS hospitals, equipped with modern equipment as well as expertise of specialist/super-specialists, based on organisational as well as perceived requirement are spread across the country. Presently the AFMS is providing contemporary, state of art super- speciality care, through designated centres/hospitals, in fields like joint replacement, advanced cardiac care, nephrology, organ transplant, vascular surgery, infertility etc. The Armed Forces Hospitals work on authorized scale of equipments called Medical Equipment (ME) Scale. In addition there is a modernization programme which is planned on annual basis and is called Annual Acquisition Plan (AAP). The Office of DGAFMS maintains a vocabulary of drugs and equipments called PVMS (Priced Vocabulary of Medical Stores) which is periodically updated. In addition, certain drugs which are not commonly used or are under the new introduction are called NIV (Not In Vocabulary). Moreover, a Central Complaint Cell functions under the Addl DGAFMS (HR) at the apex office of the AFMS at the O/o DGAFMS. All complaints/representations received at this office are critically analysed, after obtaining necessary inputs from the three medical directorates and due remedial action is taken in order to address the complaint. (Para 129) 58. In the light of the above, the Committee proposes the following for further strengthening the services provided under CGHS: (i) Mobile Dispensaries should be started at the earliest, for underserved areas. (ii) Special sessions may be organized and special cells may be maintained in all the offices for redressal of public grievances and prompt action should be taken, so that the same is not repeated in future. (iii) Separate service window may be provided to all the senior citizens for availing medical facilities viz. registration/consultation/medicine distribution etc. in hospitals/dispensaries wherever feasible. (iv) To monitor the procurement of drugs, a periodically updated vocabulary of drugs and equipments may be maintained. (v) A framework may be designed to monitor timely modernisation of infrastructure and facilities provided under CGHS. (Para 130) 59. The Committee observes that there are several other government players in the field of providing health services e.g, ESI, AFMS, IRMS etc. The Committee would like the Ministry to explore the possibility of covering all such players including CGHS under one umbrella, as an apex organisation. (Para 131)
SEPARATE SUPER-SPECIALITY HOSPITALS EXCLUSIVELY FOR CGHS BENEFICIARIES 60. Various Union Ministries and Departments have separate set up for providing health care facilities to their employees. Ministries of Railways and Defense have very wide and well- established network of dispensaries, hospitals and super speciality hospitals for their employees all 34 over the country. Similarly, Employees’ State Insurance Corporation (ESIC) has also very wide network of dispensaries, hospitals and super speciality hospitals all over the country. A considerable number of Central Government employees are residing in metro cities particularly in Delhi, Mumbai and Kolkata. All Central Government employees can avail health care facilities from the Government hospitals and some of those hospitals like Dr. Ram Manohar Hospital, Safdarjung Hospital have a separate wing for CGHS beneficiaries in some disciplines. But these hospitals are already overcrowded. It is very difficult and time consuming to avail treatment from these hospitals. Besides, almost all medicines, kits and accessories for surgery etc. are to be purchased by the beneficiaries from the open market for which they can claim reimbursement from their respective departments. (Para 132) 61. Keeping in view the above facts, the Committee strongly recommends that separate super speciality hospitals exclusively for CGHS beneficiaries, on the lines of Ministry of Railways, Defence and ESIC, one each in each metro city, where a considerable number of CGHS beneficiaries are residing along with their families, should be established so that the CGHS beneficiaries can avail super speciality treatment in these hospitals as per their convenience. (Para 133)
MEDICAL CENTRE, PARLIAMENT HOUSE ANNEXE 62. The Committee is unable to understand the reasons for which the Medical Centre, PHA has not been computerized so far whereas all the CGHS Wellness Centres have been computerized and are connected with network. The Committee, therefore, feels that the Medical Centre is required to tbe computerized immediately for keeping check and control on availability/ dispensing of medicines and other activities. The Committee strongly recommends that all vacant posts at the Medical Centre, Parliament House Annexe should be filled up immediately. There is need to strengthen the mechanism for provision of replacement of specialists in case of leave. A panel of specialists for replacement duties at the Medical Centre, PHA may be drawn up for this purpose. Old and outdated equipments should be replaced by the latest equipments and gadgets. Keeping in view the utility of physiotherapy unit and the increasing number of patients visiting there, the Physiotherapy Unit of the Centre is required to be expanded further by providing adequate manpower and the latest gadgets and equipments. In order to fill-up vacancies of the supporting staff temporarily till a permanent replacement thereof is provided in different categories, a panel of retired and experienced staff members may be prepared for the purpose. (Para 135) 63. The Committee recommends the Department to explore the feasibility of appointing a PRO for the convenience of Members of Parliament. (Para 136) 35
MINUTES
I FIRST MEETING (2010-11)
The Sub-Committee met at 12.00 NOON. on Wednesday, the 15th June, 2011 in Committee Room ‘A’, Ground Floor, Parliament House Annexe, New Delhi.
MEMBERS PRESENT
RAJYA SABHA 1. Shri Rasheed Masood — Convenor 2. Shrimati Vasanthi Stanley
LOK SABHA 3. Dr. (Shrimati) Kruparani Killi 4. Shri Ratan Singh 5. Shri M.K. Raghavan 6. Shri J.M. Aaron Rashid 7. Dr. Anup Kumar Saha 8. Shrimati Meena Singh 9. Shrimati Sarika Devendra Singh Baghel
SECRETARIAT Shrimati Vandana Garg, Additional Secretary Shri R. B. Gupta, Director Shri Dinesh Singh, Assistant Director 2. At the outset, the Convenor welcomed the Members and briefed them about the mandate of the Sub-Committee. He informed them that the Main Committee had undertaken the subject of functioning of Central Government Health Scheme for in-depth study last year. The Main Committee had accordingly held initial interaction with the representatives of the Ministry of Health and Family Welfare. The Committee had also deliberated on the subject during its study visit to Guwahati and Shillong from 22nd to 27th October, 2010. The Committee had also visited the CGHS Wellness Centres at Pusa Road, Inderpuri and Dwarka in Delhi on 6th April, 2011. 3. The Sub-Committee took note of a number of problem areas pertaining to the functioning of CGHS Wellness Centres like lack of satisfactory services for the beneficiaries, drug procurement system, empanelment of private hospitals/nursing homes/pathological testing centres, etc. 4. The Sub-Committee then discussed its further course of action. It decided to begin its study by having a briefing meeting with the representatives of the Department of Health and Family Welfare, followed by interaction with experts, stakeholders viz. Govt. Employees’ Resident Welfare
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Associations, Pensioners’ Associations and Associations of CGHS Doctors, Para-medical staff and employees. The Sub-Committee also decided to visit few CGHS dispensaries located in the National Capital Region, Medical Store Depots of CGHS. 5. The Sub-Committee also decided to issue a Press Release inviting suggestions/views on the functioning of CGHS from all stakeholders. 6. The Sub-Committee decided to hold its next meeting on the 27th June, 2011.
7. The Sub-Committee then adjourned at 12.40 P.M. 39
II SECOND MEETING (2010-11)
The Sub-Committee met at 3.00 P.M. on Monday, the 27th June, 2011 in Committee Room ‘A’, Ground Floor, Parliament House Annexe, New Delhi.
MEMBERS PRESENT
RAJYA SABHA 1. Shri Rasheed Masood — Convenor 2. Shrimati Vasanthi Stanley
LOK SABHA 3. Shri Vijay Bahuguna 4. Shri M.K. Raghavan 5. Shri J.M. Aaron Rashid 6. Dr. Arvind Kumar Sharma 7. Dr. Anup Kumar Saha 8. Shrimati Meena Singh 9. Shrimati Sarika Devendra Singh Baghel
SECRETARIAT Shrimati Vandana Garg, Additional Secretary Shri R. B. Gupta, Director Shri Dinesh Singh, Assistant Director
WITNESSES
Department of Health and Family Welfare 1. Dr. R. K. Srivastava, Director General of Health Services (DGHS) 2. Shri L.C. Goyal, Addl. Secretary & DG (CGHS) 3. Shri R. Ravi, Director 4. Dr. (Shrimati) S. Brinda, Director (CGHS)
2. At the outset, the Convenor welcomed the Members and apprised them of agenda of the meeting. The Convenor also informed them that a Press Release has been issued by the Secretariat to invite written memoranda containing suggestions/views/comments of stakeholders/organizations/ CGHS beneficiaries on various aspects pertaining to the functioning of CGHS. 3. Thereafter, the Additional Secretary and DG (CGHS) made a Power Point Presentation on the functioning of CGHS, inter alia highlighting therein the recent initiatives taken by the Department like computerization and networking of allopathic dispensaries in all cities including
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CGHS wing in RML Hospital; inclusion of new treatment procedures and investigations in CGHS Dispensaries, accredition of hospitals and labs; starting of two shifts in dispensaries in NOIDA, Gurgaon and Faridabad; introduction and issue of plastic cards; appointment of UTI-TSL as bill clearing agency for payment of hospitals bills; Grievance Redressal Mechanism etc. He also shed light on the future plans of CGHS like streamlining and computerization of the process of scrutiny of individual medical reimbursement claims, special CGHS Cells in Medical Colleges, computerization of AYUSH dispensaries in Delhi, need for Health Insurance Scheme with focus on beneficiaries of Non-CGHS areas etc. 4. During the course of the meeting, the Members raised a number of queries w.r.t. the functioning of CGHS like supply of medicines other than prescribed by specialist with similar salts and its quality and efficacy; empanelment of private hospitals particularly inclusion of more cancer hospitals in its fold; filling up of the posts of Chief Medical Officer-incharge, physician and other posts in the Medical Centre, Parliament House Annexe lying vacant for a considerable period; lackadaisical attitude of some doctors in treatment of patients at CGHS dispensaries; expansion of CGHS facility to other cities; delay in issuing plastic cards to the beneficiaries; information relating to comprehensive health insurance scheme, etc., some of which were answered by the witness. 5. The Convenor directed the Department to furnish a detailed note on the comprehensive Health Insurance Scheme and the expansion of the CGHS Scheme to other cities particularly the interaction of the Department of Health and Family Welfare with the Ministry of Finance and Planning Commission in this regard. The Committee also decided to send a detailed questionnaire on the subject to the Department. 6. A verbatim record of the proceedings of the meeting was kept.
7. The Sub-Committee then adjourned at 4.50 P.M. 41
III THIRD MEETING (2010-11)
The Sub-Committee met at 11.00 A.M. on Tuesday, the 26th July, 2011 in Committee Room ‘A’, Ground Floor, Parliament House Annexe, New Delhi.
MEMBERS PRESENT
RAJYA SABHA 1. Shri Vijay Bahuguna — In the Chair 2. Shrimati Vasanthi Stanley
LOK SABHA 3. Dr. Anup Kumar Saha 4. Shrimati Meena Singh 5. Shrimati Sarika Devendra Singh Baghel
SECRETARIAT Shri P.P.K. Ramacharyulu, Joint Secretary Shri R. B. Gupta, Director Shrimati Arpana Mendiratta, Joint Director Shri Dinesh Singh, Assistant Director
WITNESSES 1. Shri R. P. Sharma, CGHS Beneficiaries Forum, Kalkaji Extention 2. Shri H. C. Shukla, CGHS Beneficiaries Forum, Kalkaji Extention 3. Shri K. S. Kohli, Area Welfare Officer, West Patel Nagar, New Delhi 4. Shri S. Krishnan, Indian Audit and Accounts Service (Rtd.) 5. Shri Parmeshmwar, Indian Audit and Accounts Service (Rtd.) 6. Shri Inder Singh Hora, General Secretary, Pensioners and Retired Persons Association (Regd.), Janakpuri 7. Shri S.K. Chatterjee, Vice-President, Government Pensioners Association, Nagpur 8. Shri M. Jojaiah, Secretary, Government Pensioners Association Nagpur
2. At the outset,s in the absence of Convenor, the Sub-Committee voted Shri Vijay Bahuguna, MP, Lok Sabha to preside over the meeting. The Members were then apprised of the agenda of the meeting, i.e., hearing the views of some stakeholders on the functioning of Central Government Health Scheme.
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3. The Sub-Committee then first heard the views of Shri R. P. Sharma, CGHS Beneficiaries Forum, Kalkaji Extension. Shri Sharma informed the Sub-Committee that the said area had two dispensaries viz. Kalkaji I and II which had a combined population of 12,000 CGHS beneficiaries. He highlighted the following problems ailing the dispensaries (i) shortage of doctors; (ii) lack of basic facilities for senior citizens; (iii) dilapidated condition of dispensary building, (iv) majority of medicines being indented causing inconvenience to the beneficiaries; (v)lack of punctuality by Doctors; (vi) need for specialists in other disciplines like internal medicine, skin, eyes etc.; (vii) need to introduce bio-metric system for the doctors and staff to ensure punctuality and discipline as was done in some Ministries; (viii) delays in settlement of bills of empanelled hospitals thus resulting in depriving the patients of smooth healthcare services. (ix) delay in settlement of Bills of the pensioners by the Ministry was a major problem for the CGHS beneficiary. 4. Shri S. Krishnan & Shri Parmeshwar, both retired from Indian Accounts and Audit Service presented their views on the subject. They highlighted the following issues: (i) lack of medical records of patients in CGHS Dispensaries; (ii) need for the computerization of medical records of patients; (iii) need to increase frequency of visits by specialists to dispensaries on the basis of the number of beneficiaries it served; (iv) separate time for senior citizens to avoid inconvenience to them from standing in long queues; (v) need to empower CMO of the dispensary to allow diagnostic tests for patients in special cases, instead of the present system where the power is vested with the concerned specialist; (vi) need for NABH – accredited hospitals being brought under the empanelment of CGHS as they were set up on land acquired by them from Government at throwaway prices; (vii) provision of smart Cards for senior citizens to avail facility for treatment in any hospital without prior permission in case of emergency; (viii) separate dedicated wing in all government hospitals for all serving and retired Government servants; (ix) resuming evening shift in CGHS dispensaries etc. 5. Shri K. S. Kohli, Area Welfare Officer, West Patel Nagar, highlighted the following issues: (i) need to allow direct treatment in private hospital; (ii) appointment of the authorized chemist within 5 kms of the CGHS wellness centres concerned; (iii) need to subject such chemist to constant checks; (iv) setting up of more cold chains; (v) discontinuing the practice of providing substitute medicines at the stores of CGHS wellness centres; (vi) facility of yearly check up for senior citizens; (vii) need to carry out regular surprise checks by the authorities; (viii) appointment of staff on full-time basis etc. 6. Shri S. K. Chatterjee and Shri Jojaiah of the Government Pensioners Association, Nagpur informed that the retired as well as serving Government servants are staying outside the municipal area in Nagpur but were not able to avail CGHS facilities as all the CGHS wellness centres in Nagpur were located in the heart of the city. They pleaded for establishing one or two CGHS wellness centres in those areas where maximum number of Government servants were staying. 7. Shri I. S. Hora, General Secretary and Shri B. S. Rampala of Pensioners and Retired pensioners Association submitted that a separate CGHS wing with all disciplines should be there is all Government hospitals. They also felt that there was a need to make all disciplines of medicines geriatric sensitive. He was of the view that there was a need to strengthen the Ayurvedic and Unani systems of medicines at CGHS dispensaries as an alternative source of treatment and there was also a need for empanelment of more cancer hospitals for CGHS beneficiaries and Senior citizens. 8. Members raised some queries which were answered by witnesses. 9. A Verbatim Record of proceedings of the meeting was kept.
10. The Committee adjourned at 12.15 P.M. 43
I FIRST MEETING (2011-12)
The Sub-Committee met at 3.00 P.M. on Tuesday, the 11th October, 2011 in Committee Room ‘A’, Ground Floor, Parliament House Annexe, New Delhi.
MEMBERS PRESENT
RAJYA SABHA 1. Shri Rasheed Masood — Convenor
LOK SABHA 2. Shri Vijay Bahuguna 3. Shri M. K. Raghavan 4. Dr. Arvind Kumar Sharma 5. Dr. Monazir Hassan 6. Dr. Kirit Premjibhai Solanki
SECRETARIAT Shri P.P.K. Ramacharyulu, Joint Secretary Shri R. B. Gupta, Director Shrimati Arpana Mendiratta, Joint Director Shri Dinesh Singh, Assistant Director
WITNESSES 1. Dr. Janki Ballabh Jha, Retd, CMO, New Delhi. 2. Dr. Basav Gupta, Joint Secretary, All India GDMO Association and Joint Director, CGHS, Bikaner House. 3. Dr. Prakashan, Vice-President, All India CGHS Homoeopathic Doctors’ Association. 4. Dr. Talat Usmani, CMO-Incharge, Unani Dispensary, Sarojini Nagar. 2. At the outset, the Convener welcomed the Members of the Sub-Committee to the meeting. The Convener then apprised the Members about the agenda of the meeting, i.e., hearing the views of some stakeholders who had either worked or are working under the Central Government Health Scheme. 3. The Sub-Committee then first heard the views of Dr. Janki Ballabh Jha, Retd. CMO, New Delhi. Dr. Jha shared his experience as CMO in a CGHS dispensary with the sub-Committee and highlighted the various problem areas affecting the working of CGHS dispensaries. The issues raised by him included – (i) Referral to specialist by the CMO should be only for consultation and not for merely repeating prescriptions; (ii) lack of availability of specialists and polyclinic and
43 44 other services; (iii) computerization eating away the clinical examination time of the doctor as he busy writing down the prescription on the computer in the absence of an operator; (iv) coverage of CGHS beneficiaries on the lines of ECHS facility for Armed Forces personnel; (v) scarcity of CGHS hospitals; (vi) lack of facilities for senior citizens; and (vi) need for behavioral change in dispensaries etc. 4. Thereafter, Dr. Basav Gupta, Joint Secretary, All India GDMO Association and Joint Director, CGHS, Bikaner House put forth the views of the Association before the Sub-Committee. The issues raised by him on behalf of the Association included – (i) shortage of doctors, pharmacists and the clerical and supporting staff; (ii) requirement of upgradation of infrastructure as well as ambience in CGHS set-up; (iii) ill-effects of deputing the Medical Officers as OSDs to dispose of administrative work; (iv) requirement of SIU study to make realistic assessment of Doctors and staff; (v) issue of insurance coverage; (vi) need for strengthening CGHS set-up rather than making it redundant; and (vii) expansion of services and need to relook at the norms fixed for opening CGHS Centres etc. 5. Dr. Prakashan, Vice-President, All India CGHS Homoeopathic Doctors’ Association presented his views on the subject. He highlighted the following issues: (i) shortage of Homoeopathic Dispensaries and staff; (ii) requirement of two pharmacists in Homoeopathy dispensaries; (iii) pending issue of giving Non Functional Selection Grade(NFSG) to Homoeopathic doctors; and (iv) issue arising out of posting an allopathic Medical Officer as incharge of a dispensary having other systems of medicine also etc. 6. Lastly, Dr. Talat Usmani, CMO-Incharge, Unani Store, Sarojini Nagar gave a brief presentation that was based on his experience in the Unani System of Medicine in the CGHS set- up. Dr. Usmani during the course of his deposition stated that so far, during this financial year there had been no purchase of the Unani medicines as the files that were being cleared at Director (CGHS) level were now being sent to AS and DG. This had led to delay in procurement of these medicines. Dr. Usmani also highlighted the need for imparting training before a posting the pharmacists in the CGHS stores. Members raised some queries which were answered by witnesses. 7. A Verbatim Record of proceedings of the meeting was kept.
8. The Committee adjourned at 4.05 P.M. 45
II SECOND MEETING (2011-12)
The Sub-Committee met at 4.00 P.M. on Wednesday, the 6th June, 2012 in Committee Room ‘A’, Ground Floor, Parliament House Annexe, New Delhi.
MEMBERS PRESENT
RAJYA SABHA 1. Shri Balbir Punj — Convenor
LOK SABHA 2. Shri Arvind Kumar Sharma
SECRETARIAT Shri P.P.K. Ramacharyulu, Joint Secretary Shri R. B. Gupta, Director Shrimati Arpana Mendiratta, Joint Director 2. At the outset, the Convenor was apprised about the agenda of the meeting, i.e., to discuss the future course of action on the examination of functioning of Central Government Health Scheme (CGHS). 3. The Sub-Committee was of the view that it already had a fruitful interaction with many stakeholders on the subject and had already covered a large part of India except the western part of India to study the functioning of C.G.H.S. The Sub-Committee was also of the view that there is a need to undertake a local visit to some of the private hospitals empanelled under the CGHS to have a proper perspective on the facilities being provided to CGHS beneficiaries. The Sub- Committee was also of the view that the possibilities of linking all the CGHS facilities so as to allow online sharing of medical details and diagnostics reports with the consulting and referral doctors in order to obviate the need for the patient shuttling in person to do the same be explored by the Department of Health and Family Welfare. It was of the opinion that pragmatic and feasible approach be adopted for improving functioning of CGHS. 4. The Sub-Committee was of the view after undertaking the visits (local as well as outstation), it may hear the concluding views of the Secretary, Department of Health and Family Welfare alongwith the Director General, Central Government Health Services and thereafter prepare a report on the subject.
5. The Committee adjourned at 4.30 P.M.
45 46
V FIFTH MEETING (2012-13)
The Committee met at 11.30 A.M. on Wednesday, the 9th January, 2013 in Committee Room ‘A’, Ground Floor, Parliament House Annexe, New Delhi.
MEMBERS PRESENT
RAJYA SABHA 1. Shri Brajesh Pathak — Chairman 2. Dr. Vijaylaxmi Sadho 3. Shri Jagat Prakash Nadda 4. Shri Arvind Kumar Singh 5. Shri H.K. Dua
LOK SABHA 6. Shri Kirti Azad 7. Shrimati Sarika Devendra Singh Baghel 8. Mohd. Asrarul Haque 9. Dr. Tarun Mandal 10. Shri Harin Pathak 11. Dr. Anup Kumar Saha 12. Dr. Arvind Kumar Sharma 13. Dr. Raghuvansh Prasad Singh
SECRETARIAT Shri P.P.K. Ramacharyulu, Joint Secretary Shri R. B. Gupta, Director Shrimati Arpana Mendiratta, Joint Director Shri Dinesh Singh, Assistant Director
WITNESSES Ministry of Health and Family Welfare 1. Shri R.K. Jain, Additional Secretary and Director General, CGHS 2. Dr. B.C. Mahapatra, Addl. DG, CGHS 3. Dr. (Shrimati) S. Brinda, Director, CGHS 4. Shri V.P. Singh, Deputy Secretary
46 47
Armed Forces Medical Services (AFMS), Ministry Of Defence 1. Air Marshal. D.P. Joshi, Director General, AFMS 2. Maj. Gen. Rajan Chaudhry, Addl. DG, AFMS (E&S) 3. Maj. Gen. Yash Pande, Addl. DG, AFMS (HR) 4. Col.Sharad Bajpai, Director, AFMS (Coordination) Railway Health Services (RHS), Ministry of Railways 1. Shri V.K. Ramteke, Director General, RHS 2. Dr. D. P. Pande, Executive Director/Health (Planning) Employees’ State Insurance Coporation (ESIC) 1. Shri Anil Kumar Aggarwal, Director General, ESIC 2. Dr. S.K. Jain, Dy. Medical Commissioner, ESIC
I. Opening Remarks 2. The Chairman, at the outset, welcomed Members and informed them of the agenda of the meeting viz. to hear the views of (i) Shri R.K. Jain, DG, CGHS, Ministry of Health and Family Welfare, (ii) Air Marshal (Dr.) D.P. Joshi, DG, AFMS, (iii) Dr. V.K. Ramteke, DG, Railway Health Services, and (iv) Dr. Anil Kumar Agarwal, DG, Employees’ State Insurance Corporation on the functioning of Central Government Health Scheme.
II. Oral evidence of DG, CGHS, Ministry of Health and Family Welfare 3. The Committee first heard the views of Shri. R.K. Jain, Director-General , CGHS. He made a power point presentation on CGHS in which the following issues were highlighted: (i) overview of CGHS; (ii) eligibility for CGHS; (iii) categories of beneficiaries; (iv) network of empanelled hospitals and wellness centers along with the beneficiary pool under CGHS distributed city-wise etc; (v) expenditure incurred on CGHS during the last three years; (vi) recent initiatives like opening of new dispensaries in Delhi and NCR, opening of new CGHS Wellness Centres in Raipur (Chhattisgarh), Shimla(Himachal Pradesh), Panaji (Goa), Gandhinagar (Gujarat), Pudduchery, and Indore; (vii) changes in timings of CGHS Wellness centres from 7.30 a.m. to 1.30 p.m. to 9.00 a.m. to 4.00 p.m. from January, 2013; (viii) starting of cashless facility at selected private hospitals in Delhi; (ix) introduction of SMS-Alert system to check pilferage of medicines; (x) starting of rotation policy for pharmacists and other staff; (xi) delegation of powers of Add. Directors to appoint contractual doctors against vacant posts; (xii) promoting use of generic medicines; (xiii) expansion of preventive health check up facility to 8 dispensaries; (xiv) introduction of health insurance scheme for central government employees and pensioners with special emphasis on non- CGHS covered areas, etc. 4. During the course of the meeting, Members raised queries and gave their suggestions on the following issues: viz. (i) disparity in opening up of wellness centers and empanelment of hospitals among States, (ii) scanty number of CGHS Wellness Centres in North-eastern States and other distant States; (iii) criteria for empanelment of hospitals in a particular area; (iv) consideration of distance while selecting a location for construction of wellness centers; (v) reimbursement policy especially for emergency procedures; (vi) rates variation among cities; (vii) quality of doctors who cater to the CGHS beneficiaries; (viii) recruitment of nursing personnel in CGHS wellness centers; (ix) SIU norms for recruitment; (x) transfer policy; (xi) irregularity in CGHS services provided to freedom fighters; (xii) recent changes made in timings of CGHS wellness centers; (xiii) blueprint of CGHS for coming years with agenda to reach to beneficiaries; 48
(xiv) patient satisfaction; (xv) complying to the norms of patient care and time bound dealing with related issues; (xvi) reviving double shift in CGHS wellness centers; (xvii) opening up of more emergency wellness centers and upgradation of existing ones with high quality equipments and facilities along with ambulance services; (xviii) state-of-art diagnostic centers for government employees; (xix) scope of collaboration with ESI and railway health services; (xx) punctuality and availability of doctors at Parliament House Annexe wellness center; (xxi) current state of equipments and machines; (xxii) centralized drug procurement system and record of database of medicines procured and supplied to individual patients; (xxiii) increase in number of bill clearing agencies; (xxiv) reasons of payment delays; (xxv) biometric cards; (xxvi) difference in tariff of the hospitals for empanelment under CGHS; (xxvii) regular inspection of emergency (24x7) centres in order to check their effectiveness; (xxviii) provision of on-line approval for treatment on the basis of biometric card, etc. Some of the queries were answered by the witnesses. The Chairman directed the witnesses to send written replies to queries which remained unanswered, within a week’s time.
III. Oral evidence of DG, AFMS, Ministry of Defence 5. The Committee, thereafter, heard the Director General, Armed Forces Medical Services who made a power point presentation inter alia highlighting the overview of AFMS; organizational structure; medicare in armed forces; modernization of AFMS; Hospitals and Centers, military nursing centers, research activities in AFMS; medical Aid Mission; providing relief in disasters; control of HIV/AIDS in the armed forces; DNA finger printing of all armed personnel, etc. 6. During the course of the meeting, Members sought clarifications on recruitment procedure for medical professional in armed forces; facilities granted to medical personnel in armed forces; provision of more CT scan centres and increase in bed strength for South-eastern India, etc which were answered by the witnesses.
IV. Oral evidence of DG, Railways Health Services 7. The Committee, thereafter, heard the DG, Railway Health Services on the functioning of RHS. During his deposition, he inter alia stated that Indian Railway Medical Services (IRMS) has a network of 125 hospitals, 586 health units and approx. 14000 indoor hospitals with 2506 doctors including dental surgeons, 57000 paramedics including nurses, pharmacists, etc. It catered to 65 lakh beneficiaries. On an average 2.6 crore out door patients and 4.84 lakh indoor patients are attended to every year. Further around 1,30,000 surgeries are performed every year. He also explained about the procurement of drugs, empanelment of hospitals and diagnostic centres, facility for citizens, reimbursement of medical expenses and grievance redressal mechanism, etc. 8. A query was raised regarding the average response time taken by the Railways Health Services to respond to rail mishaps which was answered by the witness.
V Oral evidence of DG, ESIC 9. The Committee then heard the DG, ESI on the medical facilities provided under ESI. He inter alia highlighted that employers are required to pay contribution at the rate of 4.75 per cent of wages of the covered employees. The rate of contribution for the employees is 1.75 per cent of their wages. Further, the Corporation gets no budgetary support and different activities of the corporation are managed from the corpus of the funds generated by employer and employees. He further highlighted the issues like the medical care set-up, medical benefits available, drug procurement, empanelment of hospitals and diagnostic centres, reimbursement of medical expenses, facilities of senior citizens, medical facilities of ESI staff and retired employees, etc. 49
10. The Committee directed the DG, CGHS, Ministry of health and Family Welfare to compare the facilities available for beneficiaries in AFMS, RHS and ESIC vis-à-vis the facility available in CGHS and furnish a report for the perusal of the Committee within fifteen days indicating as to how CGHS can incorporate the better provisions of the three systems in CGHS so as to ensure maximum benefit to the CGHS beneficiaries. 11. A verbatim record of the proceedings of the meeting was kept.
12. The Committee then adjourned at 1.15 P.M. 50
XIII THIRTEENTH MEETING (2012-13)
The Committee met at 3.00 P.M. on Friday, the 26th July, 2013 in Committee Room ‘A’, Ground Floor, Parliament House Annexe, New Delhi.
MEMBERS PRESENT 1. Shri Brajesh Pathak — Chairman
RAJYA SABHA 2. Dr. Vijaylaxmi Sadho 3. Shri Rasheed Masood 4. Dr. Prabhakar Kore 5. Shri Jagat Prakash Nadda 6. Shri Arvind Kumar Singh 7. Shri H.K. Dua 8. Shrimati B. Jayashree
LOK SABHA 9. Shri Kirti Azad 10. Shri Mohd. Azharuddin 11. Shrimati Sarika Devendra Singh Baghel 12. Dr. Sucharu Ranjan Haldar 13. Dr. Monazir Hassan 14. Shri Mahabal Mishra 15. Shrimati Jayshreeben Patel 16. Shri Harin Pathak 17. Shri Ramkishun 18. Dr. Anup Kumar Saha 19. Dr. Raghuvansh Prasad Singh
SECRETARIAT Shri P.P.K. Ramacharyulu, Joint Secretary Shri R. B. Gupta, Director Shrimati Arpana Mendiratta, Joint Director Shri Dinesh Singh, Deputy Director Shri Pratap Shenoy, Committee Officer
50 51
I. Opening Remarks 2. At the outset, the Chairman welcomed Members of the Committee and apprised them of the agenda of the meeting, i.e., consideration and adoption of draft 71st Report on the Functioning of Central Government Health Scheme (CGHS).
II. Adoption of the Draft Report on Functioning of CGHS 3. The Committee then considered and discussed the draft Report on Functioning of CGHS. The Chairman invited Members to share their specific suggestions for incorporation in the Draft Report. After some discussion, some modifications such as reviewing the process of online submission of bills and approval thereof; need for review of reimbursement process and make it simpler and transparent in view of the concerns put forth by the beneficiaries; ensuring that claim adalats meant for settling pending claims are held regularly; need for direct procurement of stents from manufacturers of indigenous stents at wholesale rates rather than leaving beneficiaries at the mercy of suppliers; need to adopt a system to integrate services provided under C.G.H.S, E.S.I, defence hospitals, railway hospitals under one command; need for providing one ambulance for each emergency dispensary; need for basic equipments like E.C.G machine, glucometre in all dispensaries; need for attaching minimum of three medical stores with each dispensary within a radius of 3-5 kms.; need for having C.G.H.S facility and empanelled hospital in each district; extending cashless treatment facilities to A.M.A beneficiaries; setting up of super specialty hospitals in each metro city; starting an insurance scheme for cancer and other terminal diseases for CGHS beneficiaries, etc. were suggested by Members for incorporation in the Report. After some discussion, the Committee adopted the Report with some modifications. 4. The Committee, thereafter, decided that the Report may be presented to the Rajya Sabha and laid on the Table of the Lok Sabha on Tuesday, the 6th August, 2013. The Committee authorized its Chairman and in his absence, Shri H.K. Dua and Shri Jagat Prasad Nadda to present the Report in Rajya Sabha, and Shri Kirti Azad, and in his absence, Shri Harin Pathak to lay the Report on the Table of the Lok Sabha.
5. The Committee adjourned at 3.30 P.M.
ANNEXURES
ANNEXURE-I
List of Stakeholders/experts
List of experts, stakeholders viz. Government Employees’ Resident Welfare Associations, Pensioners’ Associations and Associations of CGHS Doctors, Para- medical staff and employees.
1. Shri R. P. Sharma, CGHS Beneficiaries Forum, Kalkaji Extention 2. Shri H. C. Shukla, CGHS Beneficiaries Forum, Kalkaji Extention 3. Shri K. S. Kohli, Area Welfare Officer, West Patel Nagar, New Delhi 4. Shri S. Krishnan, Indian Audit and Accounts Service (Rtd.) 5. Shri Parmeshmwar, Indian Audit and Accounts Service (Rtd.) 6. Shri Inder Singh Hora, General Secretary, Pensioners & Retired Persons Association (Regd.), Janakpuri 7. Shri S.K. Chatterjee, Vice President, Government Pensioners Association, Nagpur 8. Shri M. Jojaiah, Secretary, Government Pensioners Association Nagpur 9. Dr. Janki Ballabh Jha, Retd, CMO, New Delhi. 10. Dr. Basav Gupta, Joint Secretary, All India GDMO Association and Joint Director, CGHS, Bikaner House. 11. Dr. Prakashan, Vice President, All India CGHS Homeopathic Doctors’ Association. 12. Dr. Talat Usmani, CMO-Incharge, Unani Dispensary, Sarojini Nagar.
Representatives from Ministry of Health and Family Welfare 1. Shri R.K. Jain, Additional Secretary and Director General, CGHS 2. Dr. B.C. Mahapatra, Addl. DG, CGHS 3. Dr. (Shrimati) S. Brinda, Director, CGHS 4. Shri V.P. Singh, Deputy Secretary
Representatives from Armed Forces Medical Services (AFMS), Ministry Of Defence 1. Air Marshal. D.P. Joshi, Director General, AFMS 2. Maj. Gen. Rajan Chaudhry, Addl. DG, AFMS (E&S) 3. Maj. Gen. Yash Pande, Addl. DG, AFMS (HR) 4. Col. Sharad Bajpai, Director, AFMS (Coordination)
55 56
Representatives from Railway Health Services (RHS), Ministry of Railways
1. Shri V.K. Ramteke, Director General, RHS
2. Dr. D. P. Pande, Executive Director/Health (Planning)
Representatives from Employees’ State Insurance Coporation (ESIC)
1. Shri Anil Kumar Aggarwal, Director General, ESIC
2. Dr. S.K. Jain, Dy. Medical Commissioner, ESIC 57 ANNEXURE-II Siddha Yoga Total Unani CGHS Wellness Centres CGHS Wellness yurvedic Homoeopathy Allopathy A CGHS State est Bengal 18 1 2 1 0 0 22 amil Nadu 14 1 1 0 2 0 18 Uttar PradeshKarnatakaMadhya PradeshOdishaUttarakhand 7 1 10 1 0 2 2 1 1 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 9 0 0 1 14 0 0 3 0 1 Andhra PradeshRajasthanJammu and KashmirUttar Pradesh 13 1 2 5 9 0 2 1 1 0 2 1 0 0 2 0 0 0 0 19 0 0 0 0 1 0 7 12 CENTRES ACCORDING TO DIFFERENT SYSTEMS OF MEDICINES DIFFERENT SYSTEMS OF TO ACCORDING CENTRES STATEMENT SHOWING THE DETAILS OF CGHS HOSPITALS/WELLNESS OF THE DETAILS SHOWING STATEMENT 1212 Ahmedabad 33 Allahabad 4 Bangalore 5 Gujarat 4 Bhopal 6 Bhubaneswar 5 67 Chandigarh 7 891011 8 Chennai9 Dehradun Delhi T 5 1 1 1 4 0 0 0 88 0 0 13 7 0 13 0 5 0 1 1 4 124 11 Hyderabad 10 Guwahati Assam 3 0 1 0 0 0 4 1213 Jabalpur14 Jaipur Jammu 1516 Kanpur Madhya Pradesh Kolkata W 3 0 0 0 0 0 3 Sl. City No. Hospitals 58 6 1 1 1 009 26 2 3 0 0 0 31 Uttar Pradesh Maharashtra BiharJharkhandMeghalayaKerala 5 2 1 1 0 3 0 1 1 0 0 0 0 1 0 0 0 0 0 0 0 7 0 0 2 1 0 5 : 4 248 33 35 10 3 4 333 OTAL T 12 3 4 5 6 7 891011 17 Lucknow 1819 Meerut Mumabi 6 1 1 0 0 0 8 2021 Nagpur22 Patna 23 Pune24 Ranchi 25 Shillong Thiruvanthpuram Maharashtra 7 11 2 1 1 0 0 0 0 0 0 14 10 59
List of CGHS Cities and Beneficiaries State-wise
State City No. of Beneficiaries
Delhi Delhi and NCR 1396420 (NOIDA, Ghaziabad, Gurgaon and Faridabad) Andhra Pradesh Hyderabad 193684 Assam Guwahati 47543 Bihar Patna 60395 Gujarat Ahmedabad 24716 Karnataka Bengaluru 114315 Jharkhand Ranchi 9712 Kerala Trivandrum 30443 Madhya Pradesh Bhopal 131263 Jabalpur Maharashtra Mumbai 414596 Nagpur Pune Meghalaya Shillong 6544 Odisha Bhubaneshwar 17355 Rajasthan Jaipur 19466 Tamil Nadu Chennai 87605 Uttarakhand Dehradun 1067 Uttar Pradesh Allahabad 424506 Kanpur Lucknow Meerut West Bengal Kolkata 210354 Chandigarh (UT) Chandigarh 39318 Jammu and Kashmir Jammu 270
TOTAL : 3209572 60
ANNEXURE-III
Statement showing details of Plan and Non-Plan Expenditure on CGHS during Eleventh Five Year Plan (Rs. in crore) Year Plan Non-Plan Prob Total 2007-08 37.98 432.71 438.45 909.14 2008-09 52.42 498.82 498.87 1050.11 2009-10 60.39 607.37 617.16 1284.92 2010-11 64.41 602.23 645.49 1312.13 2011-12 276.87 2790.38 837.93 6105.15
Status of allocation of Plan funds and Utilisation there of by CGHS during the Eleventh Plan
Year B.E. R.E. A.E 2007-08 40.00 40.00 35.20 2008-09 50.00 59.37 45.45 2009-10 51.00 66.44 58.02 2010-11 68.65 80.81 57.21 2011-12 78.00 78.00 61.67
NOTE: The Plan funds are utilised for meeting the expenditure on account of salary and wages, purchase of medicines and all other administrative expenses incurred by some CGHS cities for which budget is allocated under Plan head only. These cities are Chandigarh, Bhopal, Bhubaneswar, Guwahati, Shillong, Dehradun, Jabalpur, Ranchi and Thiruvananthapuram. Further, the expenditure on construction of new CGHS buildings and renovation and modernization of existing ones etc. are also met form the capital works head under Plan head. CGHS has been making best efforts to utilize the Plan funds allocated to it under this head. The main reason for underutilization of the Plan funds in the long process of finalization of contracts and execution of work by the CPWD which has to follow the laid down procedures for engaging contractors and execution of work. Although CGHS releases almost entire funds timely but due to process delays, the contracts awarded through CPWD could not be finalised timely leading to time over run in many cases. CGHS has been holding regular meetings with CPWD officials and all other officers concerned to expedite the projects in order to ensure maximum utilization of Plan funds. Some progress has been noticed during the last few months in this regard.
60 61
ANNEXURE-IV
Inspection Report of Wellness Centre, Dwarka on 1.4.2011 at 8.00 A.M.
CGHS wellness centre Dwarka (No 36A) is situated in a Government accommodation near Palam Flyover. This is covering the beneficiaries staying in Dwarka sub city and adjoining earmarked areas. Earlier this area was covered by the CGHS wellness center situated at Palam. This wellness center has come into existence in April 2009. The areas are covered presently by the CGHS Wellness Centre — Dwarka Sectors 1 to 23, Raja Puri, Binda Pur, Madhu Vihar, Pochan Pur, Ambh Rahi, Bamdoli, Bharth. The name of the in-charge of the dispensary is Dr. B.C. Mahapatra who has been here since a little more than a year. There are 4 more doctors posted here but today 1 doctor is on leave and another is working part time on doctors’ advice. Out of 14 officials only 4 were present till 8-15 A.M. (including doctors). The in-charge has been there since 7-25 A.M. The Punctuality of the staff in this center is below satisfaction. Staff strength is on lower side- there is no Clerical staff; the Dresser is on the verge of retirement. The contractual doctor has been revoked after the expiry of the contract. There is no orderly or peon to do the errand. The security has been outsourced. Cleanliness is not at all satisfactory. The premises as well as the building itself are poorly maintained so far as regular cleaning is concerned. The cleaning work has however not been outsourced here and the regular cleaning staffs are apathetic to the matter of up keep and tidiness as much as possible. The wellness center has got about 7600 cards and about 26000 beneficiaries attached to it. The profile is mostly service holders with their family members – 5513 cards with 21376 beneficiaries. There are about 2056 pensioners having 4750 card holders. The wellness center has come into existence after the computerization of the CGHS services have been done in Delhi. The beneficiaries are well conversant to the On Line system of services provided by the dispensary. Issue of plastic cards has been a contentious problem in the dispensary. Many of the beneficiaries had submitted their applications for conversion of their paper cards into plastic cards in the previous center at Palam. These cards are to be obtained from that dispensary only even though the beneficiaries have been transferred to Dwarka wellness center. Another group of beneficiaries have applied in HQ at Bikaner House; the cards are being sent to the concerned dispensary via the concerned zone. The rest of the beneficiaries have applied in this dispensary whose cards are being distributed from this dispensary smoothly through a unique method innovated by the in-charge of this center. This is as under- 1. The cards are kept in a specific lot as when received from the agency who are entrusted to prepare the plastic cards. The cards are kept tidily as per Serial number in ascending order in every lot. Lots are created as per the application date and supply date. Beneficiaries can easily make out their lot number on the basis of date of application with the help of the DEO. Once the lot number of the card is ascertained the actual cards may be identified physically very easily. 61 62
2. In case the beneficiaries are not coming forward to collect the cards beyond reasonable time, another unique method has been adopted by the in-charge to inform them. The application forms are made mandatory to contain the mobile numbers of the beneficiary (mobile numbers outnumber the land line connections these days). After a specific lag period, one SMS is sent to the effect that cards have been received in this wellness centre requiring to be collected by the beneficiaries through the free web based SMS site. This method may be adopted by other wellness center to decongest the card stock. So far about 8500 cards have been received from the outsourced agency of which 1070 cards are lying undistributed (12.5%). Average daily attendance is little more than 200. The Advisory Committee is meeting every month regularly and appears to be involved in the welfare of the wellness centre. Lately the committee has been reconstituted due to inclusion of 2 new members in accordance to the laid down guidelines. Monthly performance reports are being sent regularly on line along with the hard copies of reports on family welfare and immunization. One Medical Specialist is coming on a specific day of the week. Demand is there to increase the number speciality in this respect. Medicine stock seems to have improved following betterment in supply of medicines from MSD. There is, as such no complaints about the supply and receipt of medicines. Rate contract medicines are also in good supply. Indent quantum has also decreased lately. CMO I/C is controlling ably the movement of medicines through local purchase and other sources of supply of medicines. The supplier of local Purchase is M/S Prakash Medicos. Total available number of medicines - 1 Store- 273 (RC -197, Prop-75, Gene-1), 2 Counter- 425 (RC 197, Prop- 217, Gen-11) Random check of the three areas namely- the medicine sore, counter and the local purchase did not show any gross discrepancy: The minor deficiencies have been notified to the in-charge and the concerned official. The family Welfare and the nursing activities are being done routinely. The registers require more elucidation and upkeep. Cold chain appears to be fine although the regular record maintenance is lacking. The dressing room is maintained in a small room where the part time clerk is also sitting. The necessary equipments are kept available but the maintenance is unimpressive. The Autoclave machine is in working condition. Interaction with the cross section of the beneficiaries reveal that the space constraint is there Demand for more specialist services is also there. However there are per se no gross complaints against the staff and doctors of the dispensary. The general view is a favorable one. Overall impression about the wellness centre is that the management requires to have more vigil in the matter of cleanliness and punctuality. 63
Services are provided by the Centre from April, 2009 to March, 2011
Total No. Daily Permission Immunization Copper- Number of Patients Average for tests/ of Children TS Sterilization Treated patients procedure done Inserted cases given referred April 34842 159 1335 78 05 NSV-2 to December, Tubectomy – 2009 11 January to 58344 195 1303 210 15 NSV-3 December, Tubectomy – 2010 30 January to 14684 199 1221 75 01 NSV-0 March, Tubectomy – 2011 4 Total No. of Medicines Available in the MSD Supply Items: 11 (G) + 72 (P) Wellness Centre as on Date: Rate Contract Medicines: 197 Total: 280
Expenditure of Medicines from April, 2009 to March, 2011 are us under:
2009 (April to December): Service – Rs. 5744834; Pensioner – Rs. 9492981 2010 (January to December): Service – Rs. 5154602; Pensioner – Rs. 7736354 2011 (January to March): Service – Rs. 1068194; Pensioner – Rs. 1728936
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