EMRI: An effective PPP model worth replicating : Vanam Jwala Narasimha Rao

 EMRI: An effective PPP model worth replicating

Vanam Jwala Narasimha Rao

(CPRO to CM Telangana)

(Former Lead Partner and Consultant EMRI-108 Services)

The Pioneer (20-08-2020)

Implications of one of the Supreme Court’s important judgements that “Every injured citizen brought for medical treatment should instantaneously be given medical aid to preserve life and thereafter the procedural criminal law should be allowed to operate in order to avoid negligent death” are manifold.

Safe and easy transportation of the victim to the nearest hospital through Pre-hospital care based ambulance services by governments; Provision of Emergency Response Services free of cost with speed, accuracy and efficiency either by Government on its own or in association with an experienced organization; deferring the so called formal transparent competitive bidding to implement and operationalize emergency response services by the governments like awarding of government contracts through public auction or public tender on the pretext of healthy competition etc. is the exact requirement of the judgement.

15 years later, an organization by name Emergency Management and Research Institute (EMRI) came into existence with initial funding and Technology support from B Ramalinga Raju, founder Chairman of Satyam Computers to meet the requirement of Supreme Court Judgement. Ambulance services were launched formally on August 15, 2005 by late Dr YS Raja Shekhar Reddy, the then Chief Minister of Andhra Pradesh.  

EMRI had nine basic elements namely: A Non-Profit Organization, PPP (Public Private Partnership) framework, Leadership and Partnerships, Single Toll Free 108 Number accessible from Mobile and land line, 24X7 Unique ERS staffed by Trained Personnel, Technology, Ambulance, Research and Training.

EMRI firmly believed in PPP for competitive advantage towards fulfillment of the objectives. PPP is a concept as well as practice, in which an otherwise government (Public) service is funded by state either totally or partly, and operated through a partnership between government and non-governmental organization as the case with EMRI. Bharata Ratna Late APJ Abdul Kalam and several nationally and internationally renowned great personalities like Rajat Gupta, Dr. Raj Reddy, Tarun Das, K V Kamath etc. were in its governing body in its formative days. It has a single toll-free number 108.

The Government of India during Manmohan Singh regime 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. Consequently, the then AP Government under the Reproductive and Child Health Project initiated the implementation of a scheme called Rural Emergency Health Transport Services (REHTS)  in rural areas and piloted through NGOs in four districts and tribal areas (ITDA districts) to transport pregnant women, infants and children and any other cases in need of emergency health care services to the nearest hospital in the year 2005. Initially 122 ambulances were deployed under the scheme. 

In addition to REHTS, Government of AP recognized EMRI 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 2^nd April 2005 which clearly defined the roles and responsibilities of each of them without any financial commitment from the Government. EMRI on its own deployed 70 ambulances in 50 towns (urban areas) and catered to 2.5 crore population by the end of June, 2006 and very soon could become an internationally reputed organization in providing quality ambulance services to the people.

State Government having piloted the REHTS thought of expanding the Scheme to the other 18 (Rural) districts of the state and decided to utilize the services of the EMRI as the State Level Nodal Agency for operationalizing the balance of the 310 ambulances and accordingly signed the 2^nd MoU on 22^nd September 2006. There was no tendering business. 

The third MoU signed in October 2007 further strengthened the PPP. The Government through this decided to augment 122 more ambulances initially launched in four districts and ITDA areas and were being operationalized by NGO. There was a sharing of expenditure on mutually agreed terms. Later it was agreed in principle to expand the capacity of EMRI to meet the increasing number of emergencies. A revised (4^th) MoU was signed in May, 2008 and accordingly Government added to the fleet of 502 ambulances another 150 new ambulances. 95% of the cost were to be born by government and the rest by EMRI.

Always the MoUs were signed without any formal competitive bidding process. It’s not only in AP but in several other states the same mechanism was followed.

In MP state a beginning was made with a high-level delegation from Government visiting EMRI on January 21, 2007. Then there was a series of correspondence between EMRI and MP Government. Government of MP, based on all the above decided to follow an indirect competition process and thus, a notification was issued inviting non-profit organizations for expression of interest for developing and operationalizing comprehensive emergency response service. The entire process till the signing of MoU took more than 10 months involving several validations. There was however, no direct tendering business.    

In Gujarat, when PM Narendra Modi was Chief Minister a beginning was made when Joint Secretary, Health visited EMRI in May, 2007. Then CEO EMRI and I visited Gujarat and made formal presentations. Series of correspondence followed. On 29^th August 2007, Gujarat Expansion by signing of agreement and launching at Ahmedabad took place. Thus, choosing EMRI for implementation of ERS was based on series of interactions and based on transparent procedure. There was no direct tendering business.   

In Karnataka similar procedure was followed. High-level team initially visiting and after negotiations finally MoU signing took place.  At the most there use to be a procedure known as calling for expression of interest. Thus, Rajasthan, Tamil Nadu, Assam, Meghalaya, Himachal Pradesh, Uttarakhand, Goa, Haryana, Punjab, Maharashtra etc. states started the emergency response services one after another. This was the story when I left EMRI in 2009.   

Having launched the 108-emergency response service on August 15, 2005, EMRI is currently operational in 16 States and Union Territories i.e. Telangana, Gujarat, Goa, Tamil Nadu, Karnataka, Assam, Meghalaya, West Bengal, Himachal Pradesh, Chhattisgarh, Uttar Pradesh, Rajasthan, Kerala, Delhi and Union Territories Dadra and Nagar Haveli and Daman and Diu. AP has done away with it recently. In Telangana it is yet to be decided.   

At present, there are only three players, EMRI, Ziqitza and Bharat Vikas Group who operate over 7016 ambulance services in India using 108 number. All the providers put together operate in 25 states.