RURAL EMERGENCY HEALTH TRANSPORT SCHEME (REHTS) IN ANDHRA PRADESH

UNDER PUBLIC PRIVATE PARTNERSHIP WITH
GVK-EMERGENCY MANAGEMENT AND RESEARCH INSTITUTE (GVK-EMRI)

Out of the several reasons for non-utilization of healthcare services in general and for institutional deliveries by the pregnant women in particular in rural and tribal areas, lack of transportation was found to be one of the most important reasons. Therefore, the Government of Andhra Pradesh under the Reproductive and Child Health -II Project initiated the implementation of the scheme “Rural Emergency Health Transport Services (REHTS)” in rural and tribal areas of the state.

In pursuance of the National Common Minimum Programme, Government of India launched the National Rural Health Mission (NRHM) in April 2005, for providing integrated, comprehensive primary health care services with special emphasis on poor and vulnerable sections of the society and REHTS was part of it. REHTS is aimed at transporting pregnant women, infants, children below 12 years of age and any other cases in need of emergency health care services to the nearest hospital.

In Andhra Pradesh the scheme was piloted in four districts- Kadapa, Kurnool, Mahaboobnagar, Nizamabad and the tribal areas of nine other districts in the year 2005. Initially 122 ambulances were deployed under the scheme and were operationalised through individual Non-Governmental Organizations as PPP concept in the districts, selected by a District Level Selection Committee headed by the District Collector.

Thus the Government of Andhra Pradesh successfully initiated and implemented the process of improving the accessing of healthcare services, in emergency situations by the pregnant women, neonates, parents of neonates, infants and children below 12 years of age (in situations of serious ill-health condition), and any other health emergencies in the general population; and thereby help the state to achieve the critical Millennium Development Goals in the health sector, i.e., reduction of Infant Mortality Rate, Maternal Mortality Ratio, and in general improve the health-confidence in the people through improving their ability to access healthcare service in case of emergencies.

In addition to REHTS, Government of Andhra Pradesh also recognized GVK-Emergency Management and Research Institute (GVK-EMRI)-earlier known as EMRI-a non profit organization established in April 2005, as the State Level Nodal Agency to provide comprehensive emergency response (Medical, Police and Fire) across the state, in PPP and signed Memorandum of Understanding (MoU) on 2nd April 2005. The Government also helped the GVK-EMRI in obtaining the toll-free 108 number for providing Emergency Response Services (ERS). The Chief Minister of AP Dr. YS Rajashekara Reddy launched the services on 15th August, 2005.

GVK-EMRI ‘integrates’ many resources and provides sustainable round the clock safety to citizens in PPP frame work in a timely and effective manner through SENSE (Communication and Dispatch – collects the facts about the emergency and assign the strategically located vehicle), REACH (Transport of vehicle to reach the site) and CARE (Providing the Pre-hospital care while transporting the patient/victim to the Hospital for stabilization). GVK-EMRI launched 70 ambulances from August 2005 to June 2006 covering 50 towns of 25 million populations in the state.

State Government having piloted the REHTS in four districts and ITDA areas with 122 ambulances thought of expanding the Scheme to the other 18 (Rural) districts of the state and decided to utilize the services of the GVK-EMRI as the State Level Nodal Agency and accordingly entrusted the responsibility of operationalizing the Rural Emergency Health Transportation Scheme for operationalizing the balance of the 310 ambulances and signed the 2nd MoU on 22nd September 2006. The rural expansion with GVK-EMRI as Nodal Agency was formally launched by Chief Minister of AP Dr. YS Rajashekara Reddy on January 26th, 2007.
Government of AP subsequently decided that the Ambulances in the four pilot districts and nine ITDA areas that were being run by various NGO s, also to be handed over to GVK-EMRI in the interest of unified implementation of the scheme in the rural and tribal areas with a single toll-free number-108, and extend the “free of charges” ambulances to those areas also.
The third MoU signed in October 2007 further strengthened the PPP. While retaining most of the provisions of the earlier MoU s. The Government through this decided to further expand the Public Private Partnership for strengthening the emergency services being provided by the GVK-EMRI by augmenting 122 more ambulances and also decided that 108 service would be brought under a common logo of ‘Rajiv Arogyashree’ and the logo will be prominently displayed on all the 108 ambulances and other publicity material of the scheme.

Later, Government of Andhra Pradesh decided to further expand the Public Private Partnership for strengthening the emergency services and to expand the capacity of 108 Emergency Response Services to meet the increasing number of emergencies. A revised MoU was signed between Government and GVK-EMRI on 5th May, 2008 and accordingly Government committed to provide 150 more ambulances (later another 150 ambulances) and during the financial year 2008-09, out of the direct operational cost of Rs. 1,18,420/- (One Lakh Eighteen Thousands Four Hundred and Twenty) Government agreed to bear an amount of Rs.1,12,499/- (One Lakh Twelve Thousands Four Hundred Ninety-Nine) towards its 95% share per ambulance per month (embracing the cost of call center, communication cost, additional cost on emergency management technicians, pilots, fuel and medical consumables due to enhancement of operations).

108 operations so far responded to 30 Lakh medical emergency emergencies. Under the scheme on the whole 5 Lakh+ pregnancy related emergencies were responded. It saved 47,400 lives since inception and on average per day about 44 lives are being saved now. As on today on an average 108 services are attending to 4,000 emergencies per day through 752 ambulances across the state with an average response time of 18 minutes from call to scene in urban areas and 23 minutes in rural areas. Efforts are being made to keep the response time every where less than or equal to 20 minutes. 5,200 employees, 90% of who are trained in pre hospital care and soft skills are presently working in field for operationalizing the services. Among the beneficiaries 44% belong to BC, 28% SC, 11% ST and 17% OC categories.

National Health Systems Resource Center (NHSRC) report released by Ministry of Health & Family Welfare, Government of India observed that 108 model of Andhra Pradesh and now adopted in 8 more states is a successful PPP model for ERS, to be replicated across the nation and 108 service is undoubtedly a historic landmark in the provision of healthcare in the nation. The report says: “The tremendous gratitude and praise of the family members of the emergency victim for the timely arrival of this Angel of Mercy when heard in first person is most convincing and moving and makes the service very popular. The project enjoys wide spread political support.” “The promptness with which the ambulance arrives and the pre-hospital care provided en-route speaks of its quality service. The investment in training a cadre of paramedical staff, move to institutionalize such training to create a new human resource dedicated to emergency care and equipping the ambulance with necessary requirements is laudable.”