Need for Permanent “Health and Emergency Care Developmental Fund”: Vanam Jwala Narasimha Rao

Rededicate to Health-Care

Honor the Commitments of

Former CM Rajashekhar Reddy

Appeal to Chief Minister Rosaiah

Vanam Jwala Narasimha Rao

I am shocked to see an un-believable news report in a regional television channel that the state government has decided to put on hold its share promised for the life-saving and preventive Emergency and Health schemes respectively, introduced and implemented during former Chief Minister Rajashekhara Reddy’s tenure. Having associated for more than three and half years with one of these revolutionary schemes that saved 50000+ lives in Andhra Pradesh, and continue to associate with the second now, I have every reason to express my concern when attempts are said to have been made to dislodge them.

Yes, I am talking in particular, about the most popular 108 emergency response services - the first of its kind Public Private Partnership, pre-hospital care based ambulance services in our state, which forced several state governments to replicate and introduce and run in their respective states as efficiently as in this state. Media has also been reporting for over a week that there is un-rest among a section of associates working in two very important Healthcare Institutions, EMRI (Emergency Management and Research Institute) and HMRI (Health Management and Research Institute). Preliminary enquiries by media confirm that either non-revival of the funding pattern or non-release of agreed operational expenditure in advance as per MoU norms or cuts in the unit costs on some pretext or other has become a regular phenomenon being resorted by the concern departmental heads supported by the concern Minister. The private partner is left with no option except delaying the monthly payments like salaries not to speak of annual incremental hikes. Hence the unrest in some quarters as reported in the media could be true.

The two Institutions EMRI and HMRI-one to provide 108 emergency response services and the other 104 Health Information Help Line & Fixed Date Health Service respectively are the two most successful Transformational Institutions conceived and developed in the state while Dr Rajshekhar Reddy was Chief Minster. Many thinkers and doers-some behind-have been associated in defining, conceiving, designing, developing, implementing and replicating these health-care schemes. The day is not far-off when these schemes would become instrumental in putting Hyderabad and Andhra Pradesh in the world Health-Care Map as the key Hub of reforms.

Dr. AP Ranga Rao as the Principal Advisor to EMRI, besides conceiving the idea, helped in establishing a state of the art Emergency Response System in Andhra Pradesh which paved the way for 10 more states to adopt it catering to 80 million populations. His role included providing concept, Architecture, design, algorithms, processes, monitoring tools and advocacy with Government. Thanks to EMRI and the forward thinking governments in 10 states in India, today, in almost half of India any person, round the clock, when in emergency, can be confident of transportation facility to be reached to the nearest medical stabilization center within the GOLDEN HOUR, through a net work of Pre-hospital care based Ambulances, by just dialing toll-free 108 number.

EMRI aims to provide emergency management in a way similar to, or exceed the 9-1-1 system in United States of America. The vision of EMRI is to provide leadership through Public (Not-for-profit) Private Partnership-PPP framework to respond to emergency calls round the clock and save lives meeting global standards in Emergency Management, Research and Training.

Dr Ranga Rao also as the Chief Advisor to HMRI helped in launching and scaling two very important healthcare interventions namely a 24X7 Health Help Line and the Fixed Date Health Service (FDHS). The Health Helpline provides Medical Triage and Advice, Counseling to people seeking help for psychological problems and provides information on health providers with the help of 150+ directories through 104 toll-free telephone. FDHS serves the 4.2 Crore population through a Mobile Health Unit which visits a habitation once a month focusing on pregnant women, children and the elderly.

Both EMRI and HMRI as non-profit organizations were established by the state IT icon Ramalinga Raju of erstwhile Satyam Computers Limited-now the Tech-Mahindra. Ironically, today Raju who “made the things happen” by establishing EMRI is a tainted IT icon. But, his passion to serve the people and save their lives through this unique 108 and prevent health related problems through 104 and FDHS is appreciable.

Dr Ranga Rao’s efforts and Raju’s vision of saving lives and preventing health related problems were supported and are being implemented right from day-one by another management brain behind-Dr Balaji Utla, who was initially with EMRI and moved to HMRI later and continues as its CEO till today passing through all the hard times. Venkat Changavalli as CEO of EMRI from the day the first PPP MoU was signed with AP Government five years ago in the presence of Dr Rajashekahara Reddy, through his management expertise initiated and successfully expanded EMRI to 10 states. He continues to lead EMRI despite Raju’s absence.

Much greater than these souls, was the former Chief Minister of Andhra Pradesh, Dr Y S Rajasekhara Reddy, who understood well the importance of the scheme as a doctor to save people of his state. The first-ever Public-Private Partnership health scheme started paying rich dividends as it helped save thousands of people. The concept inventor, the entrepreneur Raju, the management experts and the former Chief Minister ably supported by the then Chief Secretary J. Harinarayana as well as the then Principal Secretary Health PK Agarwal and Commissioners CBS Venkataramana & Anil Punitha carried forward the scheme further. If the EMRI concept was to help people trapped in emergency situations like ‘accidents’ or ‘sudden sickness’ reaching quickly to hospitals to provide emergency care free of cost, then the HMRI is meant to provide other than emergency health care.

In brief, These PPP Models-the Emergency Health Transportation, Health Information Help Line, Fixed Day Mobile Health Clinics and Telemedicine Center have resulted in either saving lives in emergency or helped people to plan to save their own lives preventively.

These two schemes were incorporated into the government’s Rajiv Arogya Sree, which also provides insurance cover, and are being implemented successfully in the state government. These schemes not only won many accolades from the Centre, but also from international community. As a hardcore doctor, the former Chief Minister thought providing basic Medicare is the responsibility of the government and agreed to fund cent operational expenditure (which progressively was raised from nominal to Cent Percent with his personal initiative and intervention).

Chief Minister Rosiah who as Helath Minister and Finance Minister not only supported the schemes but also provided the required funds for all the schemes under the Rajiv Arogyashri.

Other states were quick to replicate in their respective states. Believe it or, one should not shy away if a developed nation and world’s super power United States of America, too had taken a leaf out of our health scheme as the second non-white leader introducing similar Health Bill in that country.

But, today, if one has to go by the channel’s report and media stories, the 108 services are being starved of funds and the government apparently is in a mood to stop its share to support the scheme. GVK who agreed to shoulder the Private Part of the responsibility, as per the channel reports is also passive in providing funds as far as AP is concerned for reasons better known to him. Well what is the truth behind the news is anybody’s guess.

I am sure and confident that, Rajashekara Reddy’s successor, K Rosaiah, who promised not to dilute the schemes of his predecessor would initiate steps to see that the PPP services in the Health and Emergency sector are not suffered even for a minute. He as the one who evinced keen interest as the Health Minister to sign the MoU s would shoulder the responsibility to prove the Channel’s report and media stories are wrong. He should check the facts whether the Finance and Family Welfare departments have stopped funding these two unique institutions, which wedded for yeoman service.

The best way to channelize the funds would be to create a Permanent “Health and Emergency Care Developmental Fund” by pooling NRHM, State Government and Private Contributions from many but not from one single source. For such huge schemes one Raju or one GVK means "dependence in uncertainty". The operational Expenditure need to be finalized through consensus between EMRI-HMRI management and Government well in advance before the financial year commences and the agreed fund has to be deposited in a Bank account to be Jointly operated by CEO s of EMRI, HMRI and Commissioner Family Welfare. Accountability mechanisms could be worked out.

Such an arrangement do not require a Private Partner like GVK but would certainly require management experts as CEOs like Dr Balaji Utla and Venkat Changavalli. Let the PPP concept be dynamic and not static for ever with the boundaries well defined.

Any deviation from the implementation of the scheme that, brought name and fame, besides great satisfaction of serving the people in true sense and any delay in releasing operational expenditure, would send wrong signals to the people. What would be the outcome of it cannot be assessed. If these schemes fail now in future it would be difficult to bring them back again.