Public Private Partnership - A Case Study

Rogi Kalyan Samiti: An introduction The genesis of Rogi Kalyan Samiti (RKS) lies in the Indore experiment of cleaning Maharaja Yashwant Rao Hospital towards the end of 1994. The Indore district administration devised an innovative plan to overhaul the ailing health care system of the town in a way that would restore the faith of the people in the health delivery system. After an elaborate public discussion on what ails the system, every aspect and shortcoming of the system was thoroughly diagnosed. As a resultant of this dialogue Maharaja Yashwant Rao Hospital was evacuated, cleaned, refurbished and its facilities vastly improved before reopening it for public use. To ensure a degree of permanency and to prevent a relapse to its old state of decadence, a unique structure of management was introduced. This was called the Rogi Kalyan Samiti (RKS) or The Patient Welfare Committee.

The beneficiary groupProvision of basic primary health care services is a major concern of the govt. and decision-makers. With growing population and paucity of resources, primary health care has often not been up to the expectation of the people at large. While there are many initiatives that have contributed towards augmenting the primary health care initiatives of the govt., there have not been any that have had a sustained impact over a large area, for a large enough periods and affecting the lives of a large part of the populace. The public health care system does not inspire a lot of confidence among the people. Decades old crumbling public hospitals are still the only hope for a huge majority of the populace in the tribal and rural areas, inhabited by people who are most needy but least provided with adequate primary health care. RKS have carried out physical improvements and provided equipment as well as up gradation in services in many backward districts and outlying rural areas which often lack basic minimum amenities.

Products and ServicesThe RKS at different places provide many services which include:
• Ensuring regular maintenance, repairs and necessary construction/expansion of the physical facilities in the hospitals.
• Ensuring cleaning, security, hospital waste management, MIS and other services of the hospital through private agencies.
• Providing improved facilities by addition or up gradation of OT complexes; sonography, burn unit; ICCU; pediatric (ICU); CAT-scan units; centralized pathological set up etc.
• Purchase of equipment, chemicals, furniture and other necessities for efficient running of the hospitals.
• Providing improved medical facilities through purchase of modern equipment through the donation received and if required through loans from financial institutions.
• Providing a better atmosphere, facilities for attendants and ensuring improved medical facilities in general.
• Introduction of appropriate methods of disposal of medical waste.
• Providing medical care to the poor and needy free of cost or highly subsidized rates as compared to private hospitals.

Business Linkages – Strategy The RKS experiment has been a unique experience of a government - people partnership designed to address and solve one the problem of public health care. Participation of local administration along with representatives of local population is one of the keys to the success of RKS. The operating framework of RKS contributes to high levels of accountability on the one hand and increased focus on service quality on the other. It has people’s representative, health officials, local district officials, leading members of the community, representatives of the Indian Medical Association, members of the urban local bodies and Panchayati Raj representative as well as leading donors as their members. The RKS have also introduced user charges to provide for adequate finances and sustainable operations.

Rogi Kalyan Samiti: Outreach and Potential
By the end of year 2003, Rogi Kalyan Samitis had been set-up in all the districts of the State of Madhya Pradesh, which includes over 450 hospitals spanning over the 61 districts of the state. However, given the poor health infrastructure all over the country, RKS replication needs to be carried out on a much wider scale. This can help in saving many lives as well as provide people better access to health care services.

Improving the outreach of RKS will involve expansion across community classes and areas to ensure coverage. This requires advance planning, assessment to requirements & setting targets over phases as well as identification & planning for resource mobilization. The RKS can play a great role in the coming days in implementing the national health programs like immunization, Polio eradication, Fight against AIDS and other health scares.

Investment and Costs The pilot experiment of cleaning and transforming Maharaja Yashwant Rao hospital took an investment of Rs4.5 million. The funds came from the population of Indore who responded overwhelmingly to an appeal for donations. The RKS can now also raise funds through donations, loans from financial institutions, grants from government as well as other donor agencies.

Private – Public partnership opportunities The cleaning up of the MY hospital and restoration of safe & healthy surroundings has created much appreciation and widespread public acceptability. This has resulted in increased acceptance of the concept and willingness to pay charges. Resource base available with the RKS and hospitals under the RKS has increased by many folds. Health care centers in rural and semi-rural areas have proposed expansion & up gradation with the availability of internal resources generated by the RKSs. For further development, however, opportunities need to be explored. Greater private sector participation can help in bringing advanced health services at the doorstep of people living in remote areas at affordable rates.