Saga
of Emergency Response Services in India
Vanam
Jwala Narasimha Rao
Millennium
Post, New Delhi (25-02-2020)
(Former
Lead Partner and Consultant EMRI-108 Services)
The
Supreme Court of India as long back as 1989 observed 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. The effort to save the person should be the top priority not only of the
medical professional but even of the police or any other citizen who happens to
be connected with the matter or who happens to notice such an incident or a
situation. It is for the Government of India to take necessary and
immediate steps to amend various provisions of law which come in the way of
government doctors as well as other doctors in private hospitals or public hospitals
to attend to the injured or serious persons immediately”.
The implications of the judgement were broadly: 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.
Nearly 15 years later, Emergency Management and Research
Institute (EMRI) came into existence as a Non-Profit organization (Society) with
initial funding and Technology support from B Ramalinga Raju, founder Chairman of
Satyam Computers to meet the requirement of Supreme Court Judgement. EMRI was
established for bringing the benefit of the emergency response within the
affordability of a common man. He is thus, the pioneer of ERS. The brains
behind were Dr AP Ranga Rao and Venkat Changavalli.
Ever since
it was established and also in its formative years it was a great institution
with an architecture of 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 and
its leadership, ever since its establishment, firmly believed in Public Private
Partnership for competitive advantage towards fulfillment of the objectives. Public-Private-Partnership
(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. Right from Bharata Ratna Late APJ Abdul Kalam to 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 and later for a long time. 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 2nd
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 2nd MoU on 22nd
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 (4th) 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 a beginning was made with a high-level delegation from MP Government by 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 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 29th 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. It looks like 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.
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