HMRI: 104-Reasons Why It Was Not to Blame: Vanam Jwala Narasimha Rao

HMRI: 104-Reasons Why It Was Not to Blame

The New Indian Express, Hyderabad Edition

14^th July, 2011

Vanam Jwala Narasimha Rao

Consultant PPP, HMRI-104 Services and

Former Consultant PPP, EMRI-108 Services

Newspapers this week (12^th July, 2011) have reported that, the state government is intending to take control of the services 104 and 108 following alleged lapses in their functioning. The reports have said the two services will be merged in to one entity. However, some of the reports got the facts wrong. For instance, it was wrongly stated that the Government has been paying Rs. 10 Crores per month to HMRI towards bills run up by HMRI.

This is an attempt to clarify the position. The Health Management and Research Institute (HMRI) is a not for profit organization. It entered into an MoU with the Government of AP, to deliver healthcare through 104. In this endeavor, the organization received government funds only for operational expenses while management costs were always borne by its founders and patrons. All audited accounts and books of HMRI are examined every year by statutory auditors appointed by government. No adverse comments or remarks have ever been made by any agency.

The Government’s expenditure on account of HMRI operations have never-ever exceeded Rs. 8.5 Crores per month, even when the 104 Health Information Help Line, the Community Paramedic Training (CPM) program, Health Management information Systems (HMIS), the Integrated Disease Surveillance Program (IDSP) and the Fixed Day Health Service were in operation together. Neither HMRI claimed, nor Government paid, in any month, to a tune of Rs 10 Crores! Ever since Government withdrew FDHS from HMRI without even a proper notice, on December 4, 2010, citing a strike by employees, operational expenditure for the 104 never exceeded Rs. 2.07 Crores per month.

The Government has now decided to cancel the “contract” (though it was a MoU) with HMRI for running 104 Call Centre with effect from first of October. HMRI has accepted the proposal and is in the process of enabling a smooth take by the government.

As far as the capital cost is concerned all the items that come under Capital Expenditure were by and large directly procured by the government or by a procurement committee constituted by it. The assets thus procured remain in the name of government whereas the cost of the software which runs into Crores of rupees was borne by the HMRI Management.

The Health Management and Research Institute and the Commissioner Health and Family Welfare (CHFW) of the Government of AP entered in to an MOU to operationalise two important Health care Delivery services for the benefit of vulnerable sections under Public Not for Profit Private Partnership (PNPP), namely the 104 Health Information Help Line (HIHL) and the FDHS (Fixed Date Health Services). The partnership started with 104-HIHL to begin with and was extended later to FDHS.

The operational expenditure of these two services was to be born by the Government, where as HMRI would provide the knowhow and software besides developing various protocols and management. Consequent to the resignation of the Founder Chairman of HMRI in January 2009, the Piramal Group came forward to support HMRI and Ajay G. Piramal has been the Chairman since August 2010.

Since June 2010 sanctions and releases to HMRI by the Government, which were to be quarterly advances as per MOU, were gradually diluted. Quarterly advances were replaced by monthly. Since July 2010, payment delays commenced and monthly advances were almost never adhered to. This resulted in late payments of not only salaries but also other operational expenses. Often, HMRI with its limited financial resources had to step in to avoid any breakdown in the Health Care Delivery.

While this was so, there were indications from various quarters that the FDHS program was planned to be revamped and would be brought under the Cluster Health and Nutrition Centers. This caused considerable uncertainty and insecurity among the Field Staff. The 104 Contract Employees Union affiliated to CITU went on strike from November 10, 2010. Meeting the demands of the employees was not in the purview of HMRI since all of them involved policy matters and financial support from the Government. Ultimately 475 Mobile Health Units which provided once-a-month Fixed Date Health Service at every rural habitation located 3km beyond Primary Health Center aimed at reducing maternal and child mortality and screen, identify and refer non-communicable diseases, were handed over to the District Collectors.

The FDHS program had provided 2.73 lakhs Van days visited 22,500 villages on an average of 12 times and screened 116 lakhs people. More than 3.5 lakhs diabetes cases and seven lakhs hypertension cases were diagnosed and referred to doctors. Nearly 13 lakhs pregnant women were registered and on an average they were visited thrice. In addition, 20 lakhs children below 5 years and 20 lakhs school children were provided services.

Since then, HMRI has been attending to only the Health Information Help Line (HIHL) services. Since its inception it has received more than 540 lakhs calls benefiting about 200 lakhs vulnerable beneficiaries. On an average the Help Line receives 30 to 40 thousands calls daily.

Non-profit organizations try to reach the poor and the disadvantaged, but, their sustenance depends on timely funding support from the government. Hence, the survival of the PNPP model is in question. The Government has every right to continue or discontinue HMRI services. It is certainly not right to blame a service that did its work till the last minute.