E-governance for ESI Hospitals Costing of Medical Services at EsI Hospital, Bapunagar

The Employees State Insurance Corporation (ESIC) of India is one of the largest social security organizations providing medical insurance cover and delivering of medical care to 35 million beneficiaries through 140 hospitals and 1500 dispensaries. The objectives of this study are to understand the costing of medical care at ESI hospitals and suggest systems for e-governance to facilitate the coordination between ESIC, ESIS and the beneficiaries. Towards this, we selected a large ESI hospital, namely, the ESI General Hospital at Bapunagar, Ahmedabad and gained very useful insights about the systems currently in practice for offering medical benefits to the insured persons and their beneficiaries. This working paper brings out our detailed analysis of the working of ESI hospital, Bapunagar in delivering medical care under the ESI scheme.

Management Capacity Assessment for National Health Programs: A study of RCH Program in Gujarat State

The Ministry of Health and Family Welfare, Government of India administers a large number of national health programs such as Malaria control program, Blindness control program, National AIDS control program, Reproductive and Child Health (RCH) Program and so on. However, effective management of these programs has always come under scrutiny, as these programs consume a large amount of resources. As health is a state government subject in India, it is necessary to assess the management capacity of the department of Health and Family Welfare (H & FW) in each state. In this paper, we focus on the management capacity assessment for RCH program. Based on extensive literature survey, and discussions with senior officers in charge of RCH program at the centre and several states, we have developed a conceptual framework for management capacity assessment. Central to our conceptual framework are the following determinants of management capacity at the state dept of H & FW: (1) Capacity to formulate a clear statement of the state’s RCH Policy, Goals, and a Strategic Plan to achieve the Objectives, consistent with the resources available, (2) A well designed organizational structure for the H&FW department to provide the necessary support for achieving the policy goals, (3) Capacity of the H & FW department for effective management of RCH program, (4) Clear documentation of HR policies (qualifications, transfer, promotions, training etc) for RCH managers, (5) Role of External Stakeholders (6) Management Systems for Planning, Implementation and Monitoring RCH program, and (7) Institutional Processes and procedures For each of the above determinants, we have identified a set of indicators to assess the management capacity and designed a management capacity assessment tool to estimate these indicators. A pilot survey of our management capacity assessment tool in a few states helped us to refine certain instruments in our tool and finalize the same. Our management tool has been accepted by the Ministry of H & FW, Government of India and it has asked all the states and union territories to carry out a self assessment of their management capacity for RCH program. We have also recommended a suitable structure for effective management of RCH program for each state based on its population, the number of people in the reproductive age group, expected number of childbirths, and the current status of its H&FW department in delivering RCH services. This recommended structure can be used as a guideline by each state to identify its capacity gaps and take the necessary steps to augment its management capacity.

IIMA in HealthCare Management: Abstract of Publications (2000-2010)

The Indian Institute of Management, Ahmedabad (IIMA), was established in 1961 as an autonomous institution by the Government of India in collaboration with the Government of Gujarat and Indian industry. IIMA’s involvement in the health sector started with the establishment of the Public Systems Group in 1975. In the initial period, our research focused on the management of primary healthcare services and family planning. We expanded our research activities to include the management of secondary healthcare services in the 80s and to tertiary healthcare services in the 90s. Currently our research interests focus on the governance and management issues in the areas on Rural Health, Urban Health, Public Health and Hospital Management. In June 2004, IIMA Board approved the setting up of a Centre for Management Health Services (CMHS) in recognition of IIMA’s contributions to the health sector in the past and the felt need to strengthen the management of health sector in the context of socio-economic developments of our country. The overall objectives of CMHS are to address the managerial challenges in the delivery of health services to respond to the needs of different segments of our population efficiently and effectively, build institutions of excellence in the health sector, and influence health policies and wider environments. All our research projects are externally funded and we have developed research collaborations with 15-20 international universities in USA, UK, Europe, and Asia. CMHS has also established strong linkages with the Ministry of Health and Family Welfare at the national and state government levels, particularly in the states of Gujarat, Maharashtra, Rajasthan, Madhya Pradesh, Chattisgarh, Orissa, and Bihar. This working paper is a compilation of the abstracts of all our publications in the last 10 years, which include 40 referred journal articles, 54 Working Papers, 19 Chapters in Books and 18 Case Studies.

Chikungunya Epidemic Mortality in India: Lessons from 17th Century Bills of Mortality Still Relevant

Chikungunya is a virus spread by the bite of the Aedes mosquito, which recently reemerged as a massive epidemic in the Indian Ocean islands and India. Chikungunya is generally considered self-limiting and has been reported as non-fatal but, since March 2005, one-third of the 770,000 people in the Indian Ocean Island of R�union (a French territory) have been affected by Chikungunya with 237 deaths. India reported 1.3 million cases of Chikungunya however the Government of India has not reported any deaths. However there is evidence that deaths due to Chikungunya did occur. The lack of official reports of deaths is mainly due to the poor recording of ‘Causes of Death’ in India. The London Bills of Mortality from the 17th provides a very good example of the importance of proper reporting of deaths especially during an epidemic period. This paper reflects on the London bills of mortality and modern day lessons to be drawn from it as well as the reasons behind the apparent lack of death reporting in 2006’s Chikungunya epidemic.

Management of RH Services in India and the Need for Health System Reform

For the last ten to fifteen years, a comprehensive agenda of health sector reforms and health systems development has engulfed the health system in many countries in structural and organisational changes. Experience with varying degrees and types of reforms have now been reported from many countries. In our paper, we begin by describing some important issues facing the management of RH programs in India, based on our research done in a few states over the last five years. The failures in the management of RH services are complex and multi-factorial, and cannot all be addressed through health system reform. It is therefore necessary to identify which failures in service are attributable to causes, which could be removed or changed by reform in the health system. In our paper, we identify those failures and causes which could be corrected through health system reforms and propose certain concrete steps to expedite the reforms in the health system to enable the improvement of RH services in India.

Management of Blood Transfusion Services in India: An Illustrative Study of Maharashtra and Gujarat States

Blood is a vital healthcare resource routinely used in a broad range of hospital procedures. It is also a potential vector for harmful, and sometimes fatal, infectious diseases such as HIV, HBV, and HCV. Morbidity and mortality resulting from the transfusion of infected blood have far-reaching consequences. The economic cost of a failure to control the transmission of infection is visible in countries with a high prevalence of HIV. Shortfalls in blood supply have a particular impact on women with pregnancy complications, trauma victims and children with severe life-threatening anaemia. Ensuring a safe, source and ethical supply of blood and blood products and rational clinical use of blood are important public health responsibilities of every national government. Blood transfusion services in India rely on very fragmented mix of competing independent and hospital based blood banks of different levels of sophistication, serving different types of hospitals and patients. Voluntary and non-remunerated blood is in short supply. The SACS ensure only the availability of safe blood in blood banks. Clinical use of blood is not monitored, and the use of blood components is very low. Managing blood transfusion services involves donor management, blood collection, testing, processing, storing, issue of safe blood and blood products when clinically needed, and staff training. Maharashtra Government, by setting up its State Blood Transfusion Council as an independent unit under the Department of Health, has set up an excellent example to address the above managerial issues in meeting the transfusion requirements than any fragmented system. We strongly recommend the Maharashtra model to all other states and union territories in India.

Chikungunya Fever: A Killer Epidemic in Ahmedabad City, India

Background The Chikungunya virus is an alphavirus native to tropical Africa and Asia and is transmitted to humans by the bite of infected Aedes mosquitoes. The symptoms of Chikungunya include sudden onset of fever, severe arthralgia, and maculopapular rash. Thirty percent of the population on the French R�union Island was afflicted with Chikungunya in the past year. They reported 237 deaths. India on the other hand reported 1.39 million cases of Chikungunya but no deaths. Methods Mortality data from 2002-2006 was obtained from the Ahmedabad Municipal Corporation (AMC). Actual mortality rate of 2006 was compared to the mortality rate of 2002-05 and its statistical significance tests were carried out. Findings Mortality data obtained from the Ahmedabad Municipal Corporation (AMC) suggests that 3112 excess deaths occurred in August-November (epidemic period) compared to the average deaths in the same months during the previous four years. These differences in deaths were found to be highly statistically significant. A peak in excess mortality is seen in the month of September when 1489 additional deaths were recorded. Case fatality rates for Ahmedabad also turn out to be much higher than that of the Reunion Island. Interpretation The Chikungunya epidemic was raging when the excess deaths occurred. There were no other adverse events or other epidemics that took place could explain this excess mortality. Government authorities, WHO and other international public health agencies should take these findings of excess mortality seriously and investigate into this occurrence of excess deaths to understand this reemerging disease and prevent future epidemics and mortality.

Using ‘Appreciative Inquiry’ in India to improve infection control practices in maternity care : a qualitative study

ACKNOWLEDGEMENTS The inputs and facilitation of field work from the Gujarat state government officials are acknowledged. We express our gratitude to the doctors, nurses and other health facility staff for actively participating in the study. Our special thanks to Dr. Pritam Pal for capacity building of the research team for appreciative inquiry and Mr. Sanjay Joshi for follow-up of the AI process. We appreciate the help of Dr. Purvi Shah in data collection and preparing transcripts for the study. The study was funded by the John D. and Catherine T. MacArthur Foundation.Peer reviewedPublisher PD

Managerial Challenges in Addressing HIV/AIDS: Gujarat State AIDS Control Society (GSACS)

The spread of HIV/AIDS is not merely a problem of public health; it is also an economic, political, and social challenge that threatens to hinder decades of progress in different parts of Gujarat. There is an urgent need to significantly scale-up public health interventions that work to make a meaningful impact. While NGOs and community based organizations have a critical role to play in implementing these interventions amongst the various population groups, the government must shoulder the overall responsibility for planning, coordinating, mobilizing, and facilitating the various HIV/AIDS prevention, care and treatment services in the state. Generally, the departments of HIV/AIDS are dominated by doctor-managers who lack training in management. This working paper was developed with objective of enhancing the skills of the program implementers. In this paper, in first three chapters we describe the overall situation of HIV/AIDS globally and nationally. Major challenges in managing sentinel surveillance, behavior surveillance, targeted interventions and its subcomponents have been described in chapter four. Issues related to integration of HIV/AIDS activities with reproductive health has also been discussed in the chapter. In chapter five, we present a few case studies from Gujarat State AIDS Control Society. These cases focus on the managerial issues in the following areas: Project Management, Blood Bank Management, VCTC/ICTC Management, Behavioral Surveillance and MIS for Targeted Interventions. These case studies bring out the ground level realities and can help participants develop insights for better management of the HIV/AIDS programme.

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