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Affordable Health Care

Healthcare in Budget 2017-18

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Health sector policy making is extremely challenging and complex. The backdrop for policy formulation are low public spending and high out of pocket expenditures. The out of pocket expenditure on health care as a proportion of total household monthly per capita expenditure was 6.9 percent in rural areas and 5.5 percent in urban areas. Depsite India providing free care in public hospitals for maternity, new born and infant care, the burden of out of pocket expenditures remains quite high. The major policy direction is to enhance public health expenditure to 2.5% of GDP (from the present low level of ~1%) in 5 years.

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The 2017 Union Budget estimates for health show an appreciable increase of more than 27%, from Rs. 37061.55 cr in 2016-17, the budget estimate for 2017-18 has been increased to   Rs. 47352.51 cr. Further the Government has prepared an action plan to eliminate Kala-Azar and Filariasis by 2017; to eliminate Leprosy by 2018, Measles by 2020 and to eliminate Tuberculosis by 2025.

The sustainable development goals envisage that the global maternal mortality ratio will be reduced to 70 per 100,000 live births. From a baseline of 560 in 1990, the Nation has achieved an MMR of 167 in 2011. From a baseline of 126 in 1990, the Nation has achieved an U5MR of 39 in 2014. In the run up to the 2017 Union Budget, Government has formulated an action plan to reduce IMR from 39 in 2014 to 28 by 2019, and MMR 167 in 2011 to 100 by 2020. The challenges remain in the six large States of Bihar, Uttar Pradesh, Rajasthan, Madhya Pradesh, Jharkhand and Chattisgarh which account for 42 percent of national population and 56 percent of annual population increase.

India has developed a vast organization for public health care delivery and Primary care services. Infrastructure and Human Resource Development in Primary and Secondary Care Hospitals has been a key priority area. The 2017 Union Budget seeks to upgrade 1.5 lakh health sub-centres to health wellness centers and introduce a nationwide scheme for pregnant women under which Rs. 6000/- for each case will be transferred.  These steps represent significant additions to the ongoing schemes for provision of free dugs, free diagnostics and free emergency care services and free transport system for the people. A well-functioning primary health system reduces the burden on high cost secondary/ tertiary care facilities and the 2017 Union Budget takes substantial steps in this direction.

AIIMS is a national and global brand – built on more than six decades of evolution and performance of our Institute. It is the bench mark for other centres of excellence in healthcare and academics, and a fountainhead of best practices in education, research and clinical standards. The unique status of AIIMSs has been reinforced in the 2017 Union Budget by significant infusion of financial resources for major expansion. India’s Apex Medical Sciences University has enabled us to address one of the great weaknesses of Indian society – the iniquitous utilization of modern health services. High out of pocket expenses on chronic conditions can push millions of people below the poverty line.

The Government has placed a lot of emphasis on creation of several AIIMS like Institutions across India. The 2017 Union Budget has proposed establishment of 2 new AIIMS in Jharkhand and Gujarat. This would provide a huge boost to tertiary care services in public sector. Additional resource allocations for primary, secondary and tertiary care sectors lays down a roadmap for India’s path to achievement of sustainable development goals. The replication of AIIMS is quite complex because of the high-end clinical services that it encompasses. It has been a challenge to get competent faculty especially at the senior level and to retain it. Infrastructure delays have affected the utilization.

Human resources represent a vital component of India’s health care. The 2017 Union Budget seeks to create 5000 Post Graduate seats per annum to ensure adequate availability of specialist doctors to strengthen secondary and tertiary levels of healthcare. The Union Government has indicated its commitment to take necessary steps for structural transformation of the Regulatory framework of Medical Education and Practice in India. The increased availability of PG seats along with a centralized entrance exam represent major steps in reform of medical education in the country. The expansion of postgraduate medical education is a priority as the shortage of PG medical seats in the country affects not only the availability of specialist doctors but also the ease of getting faculty for medical colleges.

The collaboration between Medical Colleges and Medical Research is being firmly established. India has 32 publically funded Department of Health Research institutions. The emphasis is on evidence for policy, medical product innovation and basic research; operations research; drug discovery; frugal innovation; antimicrobial resistance; partnerships for research; and creation of databases.

The Health for All policy that the Nation had envisaged in the mid 1970s, continues be relevant to this day.

*Author is a senior civil servant, an IAS officer of 1989 batch, presently serving as Deputy Director Administration, AIIMS New Delhi.

The National Cancer Institute, AIIMS

One Year in the Making of India’s Largest Cancer Hospital

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The Health Minister has called the National Cancer Institute, the largest public health investment project of Independent India. With 710 beds, 26 Operation Theaters, 15 laboratories for Principal Investigators, a separate Diagnostics Block – the National Cancer Institute is the behemoth of Indian cancer care. Bhumi_Pujan2.jpg

At full capacity it will deploy 2700 employees and cater to 10 lac patients per annum. The design of the largest cancer hospital of India brought together India’s best cancer experts for conceptualization and design.

The National Cancer Institute is the state of the art Tertiary Cancer care cum Research Institute, being constructed at the AIIMS Jhajjar campus
in an area of 31.2 acres. It is the nodal Institution for all activities related to cancer in the country and will have linkages with all Regional Cancer Centers and other Institutes of India.Research.jpg

As India’s premier institute of cancer, its responsible for identifying priority areas for Research & Development carrying out basic and applied research in molecular biology, genomics, proteomics, cancer epidemiology, radiation biology and cancer vaccines. It is also to act as the premier center for development of human resource in various branches of cancer management depending on the needs of our country.

The Objectives of National Cancer Institute are:

(a) To provide affordable quality tertiary cancer care to cancer patients;

(b) To act as the principal agency of the country in the field of oncology;

(c) To carry out innovative research and the development of novel interventions to prevent and treat cancer;

(d) To undertake clinical trials of newer drugs as well as vaccines;

(e) To carry out transnational research and incorporate newly developed techniques in cancer therapy into clinical practice.

(f) To create international linkages with major cancer centers for exchanging cancer related information and for establishing exchange programmes for training and education.

The National Cancer Institute will have 710 beds  dedicated to treatment of those cancers which are based on research protocols. It will have equipment with latest technology.BDNCI.jpg Research will be conducted in collaboration with other cancer centers. The total personnel deployment for the National Cancer Institute has been projected at 2705. A Project Monitoring Committee under the chairmanship of Health Secretary supervises implementation and a sub-committee chaired by Head National Cancer Institute monitors the day to day progress of the project.

Following Cabinet approval for Rs. 2035 crores, the commencement of civil works took some time. The project commencement necessitated statutory approvals from local authorities. The environmental impact assessment for the National Cancer Institute required approvals from 34 agencies in the Government of Haryana. Subsequent to the Environment Impact Assessment sanctions, civil works for the Institute Block and residential block of the National Cancer Institute were awarded. The stipulated date for completion of works is March 2018 for the Institute Block and August 2018 for the Residential Block. The Machinery and Equipment Procurement will be completed by July 2018.

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December 2016 marks one year of commencement of civil works on the National Cancer Institute. The Institute Block of the National Cancer Institute comprises of several buildings namely the hospital and OPD block, Diagnostics block, Administration block, Academics block, Research Hostel for 200 students, and Service block.

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The 710 bedded, 8 storey Hospital Block has been divided between Surgical Oncology (200 beds), Medical Oncology (200 beds), Radiation Ocology (120 beds), Palliative Care (40 beds), and the remaining between Nuclear Medicine, Anaesthesia, Emergency, ICU and Day care. Necessary approvals from the Atomic Energy Regulatory Agency were obtained to commence works in the Hospital Block.

The Diagnostics Block comprises of Laboratory space for Microbiology, Central Instrumentation Facility, Haemato-Pathology, Histo-Pathology, Cytopathology, Tumor Immunology and Advanced Diagnostics Centre.

The National Cancer Institute would also have a Research (Basic Sciences) Block with 15 Principal Investigator Laboratories.

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The Academic Block would have Conference Halls, Auditorium, Office Spaces and the Faculty Cafeteria. The Research Hostel would also have a studio residence for visiting researchers and the Head NCI suite. In addition there would be the Administration Block for Office Space.

The Residential Block comprises of 216 Type III dwelling units, 84 Type IV dwelling units, 56 Type V dwelling units, 16 Type VI dwelling units, a total of 37 dwelling units.

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In addition a Hostel Block to house 440 nurses, 154 Junior Residents and 46 Senior Residents is being constructed. In 2016, a financial progress of Rs. 171 crores has been achieved. An average labor deployment of 600 per day was witnessed.

The National Cancer Institute attracted a lot of international attention in 2016 with senior faculty visits from the National Cancer Institute of Baltimore and the MD Anderson Cancer Centre Houston to AIIMS. In addition the French Academy of Medicine conducted a workshop in Toulose for a collaboration with the National Cancer Institute of France.

Looking ahead the National Cancer Institute would be amongst the great public Cancer hospitals in the world setting new benchmarks in translational research and patient care. We eagerly look forward to timely completion of works and the project being fully operationalized in 2018.

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*Author is a senior civil servant, an IAS officer of 1989 batch, presently serving as Deputy Director Administration, AIIMS New Delhi.

Making of AIIMS: The Parliament Debate

AIIMS Diamond Jubilee Celebrations conclude this month

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9th May 1956: Rajya Sabha had concluded the marathon 4 day debate on the AIIMS Bill 1956. Rajkumari Amrit Kaur in her reply to the debate spoke thus – “I want this Institute to be a unique Institute, and to be able to give our people – the young men and women doctors – the opportunities for study for post graduate education that they have not uptil now been able to have in their country. I want this to be something wonderful, of which India can be proud, and I want India to be proud of it.” The Deputy Chairman Rajya Sabha posed the Question “that the Bill be passed”. The motion was adopted, and thus AIIMS was born fifty years ago.

Introduction

The AIIMS Act 1956 provided for the establishment of the All India Institute of MedicalAll_India_Institute_of_Medical_Sciences_(Logo).jpg Sciences. It was enacted by Parliament as Act no 25 of 1956 and has a mere 29 Sections. The Business Advisory Committee of Lok Sabha had allocated only 60 minutes for discussion and passage of the Legislation. The Bill aroused tremendous enthusiasm amongst Members of Parliament and was debated for 3 days from 18th to 21st February 1956 in the Lok Sabha and 4 days from 3rd May to 9th May 1956 in the Rajya Sabha. The Parliamentary records of the debate run into over 800 pages.

Moving the Bill in Lok Sabha

18th February 1956: When the Minister of Health Rajkumari Amrit Kaur rose in the Lok Sabha to move the Bill, she did not have a prepared text of her speech. She spoke from the notes that she carried and from her heart. “It has been one of my cherished dreams that for post graduate study and for the maintenance of high standards of medical education in our country, we should have an institute of this nature which would enable our young men and women to have their post graduate education in their own country. It will provide under graduate study to only a very limited few. The major emphasis will be on post graduate study and specialization.” The two special features of the Institute, which is the first of its kind in India and the first of its kind in Asia, are prohibition of private practice of every form and to pay the doctors reasonably high salaries to compensate them for the loss of private practice. The doctors of AIIMS would devote their whole time not only to teaching, not only to serving the patients who come to the hospital but also to research. All the staff and students were to be housed in the campus of the Institute in the best traditions of the Guru-Sishya ideal to stay in close touch with each other.

The Debate

The Members of Parliament across party lines in the Lok Sabha overwhelmingly supported the revolutionary changes in medical education envisaged by the AIIMS Bill 1956. Commencing the debate Dr. Rama Rao Member of Parliament from Kakinada, said the Institute should have more under-graduate seats, given that very limited opportunities were available in India. T.S.A.Chettiar Member of Parliament from Tiruppur said that the composition of the Institute should provide that the majority of the members should be non-officials. In addition to accounts being submitted to Parliament, the Institute should lay an annual report of its activities in both the Houses of Parliament. This proposal of T.S.A.Chettiar was incorporated in the AIIMS Act by a subsequent amendment. He further said that practical training for doctors in rural and urban areas cannot be provided on the campus of the Institute and the Institute should have a hospital where practical training can be provided. This is reflected in the Community Health Centre at Ballabhgarh, (in the vicinity of Delhi) which is administered by the Institute where undergraduate doctors are sent for practical training.

Shrimati Jayashri MP from Bombay Suburban said that the nursing college of AIIMS should be a path bearer for the other nursing colleges of the Nation. Shri Narayan Das MP from Darbhanga said that the Government must provide adequate finances to the Institute. Mohanlal Saksena who represented Lucknow in the House, said that the AIIMS was going to be an autonomous body and Parliament will not have much control over it. Several members also raised the need to incorporate Ayurveda, Homeopathy and other indigenous systems of medicine into the AIIMS which was a recurring theme in the Rajya Sabha debate also. Even as the Bill was put to clause by clause voting, Joachim Alva Member of Parliament from Kanara expressed concern that the Director who is to be appointed by the Government could perhaps be a retired politician – “a Khushamadi” who may not have done any teaching or operative work or anything of that sort for nearly two decades.

In her reply to the debate in Lok Sabha, the Health Minister, said that the Governing body would comprise of a majority of non-officials. She maintained that the name All India Institute of Medical Sciences was all inclusive and apt.  She assured the members that the selection of Professors by a Standing Selection Committee has been agreed to by UPSC. She further clarified that while Rules will be made by Government, Regulations dealing with a wide variety of subjects pertaining to administration will be formulated by the Institute. The AIIMS Bill was thus passed by Lok Sabha with a single amendment that AIIMS shall lay an annual report through Central Government in both Houses of Parliament.

The Bill’s Journey in Rajya Sabha

3rd May 1956: Introducing the Bill in the Rajya Sabha, the Union Health Minister Rajkumari Amrit Kaur said “The future of the Institute will lie in the hands of the Director, of the Professors and other Members of the teaching staff and students. I believe that it will be their devotion to duty, their desire to promote their work and their spirit of altruism that will actuate them to subordinate their personal considerations as I believe the noble profession of medicine should do to the fulfillment of the objectives in view, that will eventually create and maintain an atmosphere which is necessary for an Institute like this. I do therefore, hope that in presenting the Bill for acceptance by the Rajya Sabha today, the legal structure that is crafted may facilitate the progressive realization of improved methods of medical education in this Institute and through its influence the standards of different courses of professional training in the field of health throughout this country will be raised.” She informed Members that Dr. B.B.Dixit has been appointed as the first Director of the Institute given his research experience at the Haffkine Institute and the administrative experience as Surgeon-General of Bombay.

Concluding her introductory remarks, the Health Minister maintained that “Subject to such minimum control as the Government of India may exercise through its rule making power, the Institute will enjoy a very large measure of autonomy to fulfill its objectives.”

The Debate in the Rajya Sabha

Though the Members of the Rajya Sabha were overwhelmingly in support of the Bill, for establishing an All India Institute of Medical Sciences facilitating for higher instruction in modern medicine, yet many felt that the legislation lacked clarity and envisaged excessive delegation to executive authority in the Rules. Members said that out of 30 clauses in the Bill as many as 25 clauses contained the provision, “prescribed by Rules” and 11 clauses contained the provision “prescribed by regulations”. While delegated legislation comes with every Act, the AIIMS Bill sought extraordinary delegation to executive authority. The powers of the Medical Council to grant degrees and diplomas and the powers of the UPSC to conduct selections were delegated to the Institute. Several members expressed concern at the total omission of references to indigenous systems of medicine in the Bill and felt that the focus should also be on Ayurveda, Homeopathy and Unani systems of medicine. Biswanath Das Member of Parliament from Orissa said that the Health Minister who received inspiration from Mahatma Gandhi was making Ayurveda an untouchable system. Some Members also felt that the Dental College and Nursing College were not required at AIIMS and the focus should be on high-end research work.

Commencing the debate P.N.Sapru Member of Parliament from Uttar Pradesh said that “We cannot agree to the suggestion that the shaping of the Institute in its technical aspect should be entrusted to the Director and the Professors of the Institute acting as a medical faculty. There is danger, under a constitution of this character, of the academic faculty of the Institute developing into a closed corporation of mutual admiration. There must be representation of an expert character – representation of an outside expert character – provided in the constitution itself.”

Participating in the debate, Dr Radha Kumud Mookerji, nominated Member of Parliament, sought clarifications on Clause 5 of the Bill which says that “AIIMS will be an Institute of National Importance”. He felt that the scope of National importance must be wide enough to cover all systems of medicine prevailing in the country – systems of medicine which have survived the onslaught of the ages. Similar views were expressed by H.P.Saksena Member of Parliament from Uttar Pradesh on clause 5. He said that the Institute of National Importance should demonstrate a high standard of medical education to all other medical colleges and other allied institutions in India. Dr. W.S.Barlingay an MP from Madhya Pradesh laid emphasis on the Objects of the Institute to develop patterns of teaching in medical education as a critical component of the Institute’s focus areas. He felt that the Institute could be attached to Delhi University which could grant diplomas and degrees as also get grants from University Grants Commission.

Passing of the historic Motion

In her reply to the debate, Rajkumari Amrit Kaur provided answers to the concerns expressed by Members. She argued that the Institute shall have the power to grant medical degrees, diplomas and other academic distinctions and titles under the Act of 1956. She maintained that Dentistry was has been a very neglected science in India and dentists have to go abroad to get first class qualifications. Hence a Dental College was attached to the Institute. Similarly she said, Nursing was the most neglected limb of the medical profession though it was an important hub. She said she had consulted UPSC on the recruitment to faculty posts. UPSC was of the view that because AIIMS will be a statutory non-government institution, recruitment will be outside the purview of UPSC. With regard to excessive delegated legislation being taken by Executive, she said that Parliament should give as much autonomy as it can to this Institute, which is going to be a pioneer venture. “Let us have elasticity and let us have autonomy…after all you are going to have an extremely good Governing Body which will lay down the policies which will be followed by the Institute and the regulations must be left to the discretion of the Institute itself…the Government will be in very close touch with the Governing Body. Trust your Government, Trust your Scientific People…”. She promised to develop an All India Institute for Ayurveda at Jamnagar and al All India Institute for Homeopathy in future as also a chair for History of Medicine.

The Bill was put to vote on the 4th day of the debate on 9th May 1956. Clearly, the Health Minister was exhausted by the 4th day of the debate. Even as the Bill was about to be passed Members continued to press for amendments in the clauses and it appears from a reading of the debate that the Health Minister showed some irritation in the House. Dr. Seeta Parmanand Member of Parliament from Madhya Pradesh said that “Sir, after all it is the right of this House, if at all they feel that something should be done by the Ministry, to criticize the Ministry. She called herself the Chief Servant of her Ministry. She is there to reply.”  Despite these moments of acrimony, the Bill received support from all the Members of the House and the motion to pass the Bill was adopted leading to the establishment of AIIMS,

*Author is a senior civil servant, an IAS officer of 1989 batch, presently serving as Deputy Director Administration, AIIMS New Delhi.

AIIMS GOES DIGITAL

The First Digital Revolution in Health Care

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Author : V. Srinivas

Introduction

Building strong Institutions is one of the major objectives of Good Governance. The Digital India initiative represents a landmark in ushering in the First Digital Revolution in Health Care at AIIMS. The successful implementation of the AIIMS e-Hospital Project and the AIIMS OPD Transformation Project, transformed AIIMS to India’s first fully digital public hospital. In 16 months of implementation since the launch in July 2015, the AIIMS e-Hospital project has had the largest footprint of Digital India projects.

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The creation of a patient friendly hospital has benefitted 35 lac patients till date, reducing wait times at the Hospital by nearly 6 hours, brought transparency to OPD appointments; created digital medical records and represents a sustainable and replicable model for hundreds of India’s Hospitals.

The Challenge

The very name invokes images of crowds, a sea of humanity that is present at the hospital doors, waiting from 3  in the morning, to rush for expert medical consultation at 8.30 am when the OPD opens.

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With an average of 10,000 OPD patients per day, 35 lac OPD patients per annum,  55 Departments, 640 faculty, 2000 resident doctors and 5100 Nurses,  AIIMS represents India’s behemoth in tertiary care super specialty hospitals.

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While the Institute led by highly driven professionals works with clockwork precision, the overwhelming patient loads have proved impossibly challenging for a manual system and required significant systemic changes in terms of improved digital practices and process re-engineering, as millions of India’s population seeks medical care at the Nation’s apex Medical Sciences University.

AIIMS – UIDAI – DeiTY Collaboration:

It was in January 2015 that the first step in the Digital AIIMS project was taken with the creation of an effective linkage between AIIMS, Unique Identification Authority of India (UIDAI) and the Department of Electronics and Information Technology (DeiTY).

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A unique health identification number for every patient visiting AIIMS was generated on an Aadhar platform. The patient could log into the AIIMS OPD Appointment System (ORS.gov.in) and submit a request for an appointment online using his Aadhar number. The verification of the demographic details of the Patient was based on the one-time password for the patient being transmitted to the mobile phone number of the patient registered in the Aadhar data base. The Unique Health Identification Number gave every Patient visiting AIIMS a Digital Identity. The Patient could use the UHID for his entire lifetime and every consultation visit was documented by the system.

The e-Hospital project proceeding at a modest pace, suddenly gained significant momentum with the launch of Digital India Initiative. There was a new urgency in DeiTY and NIC for expeditious development of the software so that the Online Registration System could be established. This was followed by the collaboration between AIIMS and Pay Gov for creation of a payment portal.

The e-Hospital project necessitated transparency in OPD appointments. AIIMS always encouraged walk-in patients and also had several follow-up patients coming for consultation. The streamlining of the new OPD cases began with 15 percent of the total new OPD appointments being given for online registration. The out-patient appointments of each of the Departments of AIIMS was placed online and every consultation room in the OPD was allotted a fixed number of OPD patients identified by name.

AIIMS – TCS Collaboration:

The AIIMS-TCS collaboration for the AIIMS OPD Transformation Project was conceptualized as a Corporate Social Responsibility Project in April 2015. It was only after several months of observations at OPD followed by conceptualization, discussions, capacity building, consensus building and software development that the TCS prescribed a model of AIIMS OPD transformation.

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The approach was to facilitate faster registration, to dissipate crowds with larger patient waiting areas, introduction of several new measures like fresh signages, screening at the entry point, patient care coordinators at the registration/ consultation areas and the rather unique exit OPD counters for all follow-up patients. Today, the AIIMS-TCS collaboration has provided the country with a role model for transforming OPD services at all major Central and State Government Hospitals.

The newly adopted model envisaged construction of a Patient Registration Center, with 50 Registration Counters each one equipped with a computer terminal loaded with e-Hospital software. It was constructed and operationalized in a record time of six months.

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Now the registration time was a mere 40 seconds for all new appointments with UHID numbers generated from the online registration system. Fast Track Queues were created where the patients who had already registered themselves under the online registration system could get their OPD cards and move quickly to the Patient Waiting Areas. Patient Care Coordinators ensured that Patients understood clearly where to visit during the entire process. The whole approach was one of empathy and efficiency. The successful operationalization of the Patient Registration Center meant that the waiting time in the Hospital had come down by nearly 6 hours per patient. The 3 am serpentine lines were no longer there. They were replaced by a more orderly queue system that commenced at 8 am and reached the OPD consultation rooms by 9 am.

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AIIMS attracts 10,000 patients per day but the patient waiting areas had only 2500 seating capacity. This meant that patients rushed to consultation areas without any wait time in a comfortable environment. The TCS model envisaged creation of seating spaces for an additional 3500 patients. Air conditioned Patient Waiting Halls were developed where the patients could comfortably wait for their turn to visit the OPD Consultation rooms.

Initially, the new model was implemented in the Medicine and Pediatric OPD areas on a pilot scale in December 2015. The Clinicians would commence work at 9 am. Patients would reach the clinician’s rooms in an orderly manner. All multiple registration counters in these Departments were discontinued. The successful implementation encouraged AIIMS to introduce the model in all the 5 floors of the Rajkumari Amrit Kaur OPD covering all 55 Departments.

The most innovative feature of the new model was the introduction of EXIT OPD Counters. Patients who were recommended for advanced Laboratory Tests, Radio-Diagnosis, Virology and Pathology Tests as follow-up appointments, all of which could be scheduled from the EXIT OPD Counters. The Patient thus had a very orderly journey from the point of entry to the Hospital to the point of exit. Even the VIP Patients including the officials at senior position in government willingly went through the entire OPD Transformation Process and found the entire experience quite expeditious and satisfying.

Specialised Cadres

AIIMS transformed itself into a patient friendly hospital by its willingness to adopt the modern day digital practices and create specialized cadres who enabled rapid scaling up of the new technology. The Nursing Informatics Specialists provided the linkage between the Clinical Departments and the OPD appointments. Nurses with an aptitude for technology were deployed to coordinate between the Departments, OPD, Wards and the software professionals.

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The Patient Care Coordinators touched every patient entering the OPD with their empathy. They were the friends and guides who ensured patients followed the established protocols. They were also deployed to assist with the E-Kiosks to enable literate and tech savvy patients with appointments.

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The Data Entry Operators were deployed at Patient Registration Center and the EXIT OPD Counters. They were trained to handle cash collections simultaneously. Security Personnel were trained in Queue Management systems with a considerable degree of patience.

AIIMS–India’s First Fully Digital Public Hospital

Hitherto, the implementation of the e-Hospital project had not been orderly. For AIIMS to be a fully Digital Hospital, each of the e-Hospital modules needed to implemented in an orderly manner to create a comprehensively digital hospital. By June 2016, the e-Hospital module implementation in AIIMS was completed. The NIC took a big step forward in completing the AIIMS e-Hospital Project. NIC Teams from Tripura worked with each of the Departments in AIIMS in a prescribed time frame to transform AIIMS as India’s first fully digital public hospital. The modules comprised of Blood Bank module, Billing Module, In-Patient Department comprising admission and bed to bed management, Laboratory Module integrating 55 laboratories, establishment of nearly 200 Kiosks with Net Banking Facilities for ease of payments, Laundry Module for monitoring the central laundry operations, Store management for inventory purposes, Dietary Module for preparation of electronic diet charts for in-patients, and RIS-PACS (Radiology Imaging System – Picture Archiving Communications System) for exchange of radiology data.

The Titanic is Saved

The transformation of AIIMS to a patient friendly hospital under the Digital India Initiative can be compared to “Saving the Titanic”. Under the Digital India Initiative, a core team of officials collaborated cordially and constructively over a long period of time to make the First Digital Revolution in Health Care possible.

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There was considerable resistance from every possible quarters– patients, support and administrative staff, security apparatus and even some medicos had their share of doubt during the course of the implementation of the Project. Needless to say, now everyone is satisfied and happy. As the success story unfolds benefitting 35 lakh patients, in 12 months’ time, the hours and hours of effort put in by those involved in the project, are adequately rewarded. The Prime Minister launched the Online Registration System as part of the Digital India Initiatives in July 2015. Following a year of successful implementation wherein the project benefitted 35 lac patients, the Prime Minister mentioned the successful implementation of the AIIMS e-Hospital Project from the ramparts of Red Fort in his Independence Day Address this year. The AIIMS OPD Transformation Project has enthused several State Governments. AIIMS has been mandated to conduct on-boarding workshops for replication across all 12 Central Government Hospitals.

Thus the AIIMS Transformation Project represents India’s First Digital Revolution in Health Care. No doubt, it is a remarkable success story.

 

*Author is a senior civil servant, an IAS officer of 1989 batch, presently serving as Deputy Director Administration, AIIMS New Delhi.

Raj Kumari Amrit Kaur

AIIMS Diamond Jubilee Celebrations

– a PIB Feature by Shri V. Srinivas*

Rajkumari Amrit Kaur became the First President of AIIMS at the age of 67, a position she held from 1957 till her demise in 1964. Her contribution to the governance and institution building at AIIMS are legendary. The Princess of Kapurthala had her early education at Oxford University. She was awarded the Doctor of Laws by Princeton University in 1956. She joined the Mahatma’s Ashram in 1934 and served as his Secretary for 16 years. She spent three years in prison for participating in the Quit India movement. She became the first woman to hold a Cabinet rank in Nehru’s Cabinet and the President of the World Health Assembly in 1950. It can be said that without her visionary leadership, AIIMS would not have reached the heights of excellence that it has scaled over the past 6 decades to emerge as the premier Medical Sciences University of India.

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Rajkumari Amrit Kaur chaired the first meeting of the Governing Body in 1957. In her eight-year tenure, she chaired 25 Governing Body Meetings. Dr Jivraj Mehta the Director General Health Services and Dr. B.B.Dixit Director AIIMS served with her for the entire period. She got an IAS officer as Deputy Director for running the administration for a 12-year tenure to ensure stability in the process of Institution Building. The first Governing Body meeting underscored the massive governance challenge before the AIIMS administration of establishing the Institute as an apex medical sciences University with tight budgets, lack of adequate personnel, absence of infrastructure and dependency on foreign funding. It set the foundations for a governance structure where high level policy support and interventions for the Institute’s growth were available as the President AIIMS took upon herself the responsibility of coordination with the Health Ministers of State Governments, coordination with Union of India for additional budgetary allocations and for delegation of adequate administrative and financial powers to Director AIIMS.

1st Governing Body of AIIMS

The first Governing Body meeting of AIIMS was convened on 27th May 1957. The Governing Body members who attended the meeting included Rajkumari Amrit Kaur in the chair, Dr. A.L.Mudaliar, Dr. Jivraj Mehta, Lt. Col Jaswant Singh Director General Health Services, Lt Col Amir Chand, Dr. R.M.Kasliwal and Dr B.B.Dixit Director AIIMS. The Union Health Secretary was not a member of the Governing Body although the Joint Secretary Ministry of Finance was a member of the Governing Body.

The Budget for the year 1957-58 was Rs. 40 lacs and the entire 2nd Five Year Plan allocation for AIIMS was Rs. 11.11 crores. As the budget was not adequate for the construction of the hospital building upto the end of the 3rdFive Year Plan period, the Governing Body decided to approach the Government of India to transfer the Safdarjang hospital to the Institute. The Institute also accepted donations from the Rockefeller Foundation for a grant of USD 200,000 for purchase of books and publications and scientific equipment. Amongst the important decisions of the Governing Body was to consider and adopt the Regulations of AIIMS.

The Governing Body considered the half-yearly progress report of AIIMS and rated the performance of the Institute “Very Good”, despite the insufficient staff. The Director was mandated to identify suitable candidates for the posts of Professor of General Surgery, Head of Department of Medicine, Head of Department of Preventive & Social Medicine and Professor of Anesthesiology. The services of Prof H.M.Smetana were made available by the Delhi University for the post of Professor of Preventive and Social Medicine, which was sponsored by the Rockefeller Foundation. However obtaining services of Dr. P.N. Wahi for the post of Head of Department of Pathology from the Government of Uttar Pradesh and the services of Dr Srivastava and Dr Balakrishnan for the posts of Professors of Medicine from the Government of Bombay was not possible. The State Governments of Uttar Pradesh and Bombay insisted on their prior resignation and Institute could not protect their past services. So tight was the budgetary allocation that the Institute accepted the sponsorship of the Rockefeller Foundation for air conditioning of the Institute building as it was felt that constructing the building without air conditioning was impossible.

60 Teaching Beds of Safdarjang and New Zealand Grant

The decision not to construct a Hospital for AIIMS was taken in view of the lack of finances and increased cost on their buildings and equipment and was deferred till the 3rd Five Year Plan. Dr Jivraj Mehta as Director General Health Services offered 60 beds in Safdarjang Hospital for teaching purposes for the Departments of Medicine and Surgery as Professors had been appointed in these Departments. That said, the Institute accepted the Pounds 1 million grant from New Zealand for construction of the Hospital at the Institute and construction was taken up in the 2nd Plan Period.

AIIMS becomes autonomous in November 1956

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Rajkumari Amrit Kaur protected the autonomous nature of the Institute. She maintained that the Institute became autonomous from 15th November 1956 and all posts with a minimum pay of Rs. 600/- per month or more would be created with the approval of the Government, while no prior approval was necessary for posts carrying a minimum pay of less than Rs. 600/- per month. It was based on this decision that the Governing Body decided to fill 35 posts of Assistant Professors without prior approval of Government.

The Governing Body ensured that the autonomous nature of the Institute was preserved. Rajkumari Amrit Kaur had created an international face for the Institute by collaborations with Rockefeller Foundation and the Government of New Zealand and encouraged further collaboration with the University of Pittsburgh. The AIIMS insignia was approved by the Governing Body in 1958 and slogan “shariramadhyam khalu dharma sadhanam” was decided in consultation with Vice President Dr. S. Radhakrishnan. Rajkumari Amrit Kaur permitted Governing Body meetings to be chaired by Dr. Jivraj Mehta in her absence. Dr Jivraj Mehta led Governing Body decided to relax conditions of admission to candidates of Nepal under the technical cooperation scheme of the Colombo Plan as also students from Burma. The Institute permitted exchange of post graduate students by sending AIIMS senior students abroad and getting some students from abroad. The Nursing College at Delhi was shifted to the Institute and amalgamated with it in 1958.

The Apex Medical Sciences University

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The discussions in the Governing Body indicate the passion with which Rajkumari Amrit Kaur pursued institution building. By 1959, the Institute had 350 beds at the Institute and 84 teaching beds for medical and surgical cases at the Safdarjang Hospital in addition to the Nursing College. The Institute continued to make out a case for the transfer of the Safdarjang Hospital to the Institute in addition to the 650 beds that were planned for the Institute.

Rajkumari Amrit Kaur maintained that the AIIMS be mandated with the responsibility of developing teaching patterns in Under Graduate and Post Graduate Medical Education to all medical colleges and allied institutions of the country. It was for this reason that she said she chaired the Governing Body of the Institute and would run it as an autonomous institute through the Standing Committees namely Finance Committee and Selection Committee both chaired by Dr. Jivraj Mehta the Director General Health Services, the Academic Committee and the Building Committee. The Membership of the Institute Body was pan-India representative, with medical faculties from Indian Universities, Members of Parliament, Distinguished Medical Educationists, members of the Indian Science Congress and representatives of Ministries of Education and Finance. The close collaboration of AIIMS with the Indian Medical Council, the Indian Council of Medical Research were developed in pursuance of the objective of developing the apex Medical Sciences University of India.

Rajkumari Amrit Kaur’s vision envisaged selection of students for admission to the under-graduate MBBS course in AIIMS is made after an open advertisement, on the results of an open competitive test, strictly on merit with equal opportunities to students from any part of the country. It was with this backdrop, the AIIMS entrance examination was conducted in 5 cities in 1956, 1957 and 1958 namely Bombay, Calcutta, Madras, Nagpur and Delhi with 400 candidates appearing for 50 MBBS seats.

Global recognition

The performance of AIIMS by 1961 was noticed in international fora. The Massachusetts General Hospital on the occasion of its 150th celebrations, placed AIIMS in the list of most distinguished hospitals of America, Canada and Europe and presented Rajkumari Amrit Kaur with a medallion and a ‘Book of Citation’. Dr. B.B.Dixit in his letter to the Chairman, Board of Trustees Massachusetts General Hospital mentions how greatly AIIMS would cherish the citation – “This undertaking unites education and research in a courageous manner to meet the health needs of 400 million people” and AIIMs shall try its best to live up to these expectations.

Manorville

Image courtesy: Outlook India Magazine

Rajkumari Amrit Kaur chaired her last Governing Body meeting of AIIMS on 14th August 1963. The Governing Body accepted her gift of “Manorville”, her residential building at summer hill Shimla to the Institute for rest and relaxation of doctors and nurses of AIIMS. A truly unparalleled gesture in the history of the Institute.

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*The author is a senior civil servant, an IAS officer of 1989 batch, presently serving as Deputy Director Administration, AIIMS New Delhi. The views expressed in the article are personal.

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