Rogi Kalyan Samiti

Last update: 10/09/08

          Introduction

Rogi Kalyan Samiti  are  the registered societies  constituted in the hospitals as  an innovative mechanism to  involve the peoples  representatives in the management of the  hospital with a  view to improve its  functioning through levying user charges.

 

Traditionally, in a welfare State the delivery of health care to general population has been within the domain of public sector. Health care institutions at the districts and sub-district level have been funded by the Government. It has been estimated that 5 percent of the GDF  is spent on the health care.  Of this more than three-quarters are financed by the private sector, which is mostly out-of-pocket. This large out-of-pocket expenditure on health care exists even though the role of the government in financing and providing almost free health care has been emphasized since the time of independence. A large population, challenges of infectious and communicable diseases on one hand and life style diseases like cancer, AIDS, and coronary diseases on the other hand, and improving medical technology are some of the factors which contribute to increased costs of financing health care  However, the availability of funds has been grossly inadequate when compared to the requirement.

 

Over the years, people developed a mindset that welfare of the common masses was solely the responsibility of Government and it is the Government which is expected to provide the finances without people being required to make any contribution in this regard. Growing population stretched the facilities in Health institutions run by the Government to limits,  where policy makers and the people were drawn together to think in terms of joint ventures to deliver better Health Care.

 

During the last few decades, there have been isolated efforts at involving the people in augmenting physical infrastructure in Government Health institutions. These efforts, however, were based on personal commitment and initiative. Given the short tenures of Government Officials, these initiatives could not be sustained. Therefore, a debate had been put on board to  crystallize the idea of a system of sustainable Public-Private partnership for improved Health Care in the Government sector  and implemented as Rogi Kalyan  Samiti by Govt. order. Instead of assuming a zero-sum relationship between Government involvement and private co-operative efforts, some social capital theorists argue about the possibility of 'state-society synergy'. They hold the view that an active government and mobilized communities can enhance each other's developmental efforts. In the construction of synergy, micro level social capital has an important place. The Government of Madhya Pradesh has effectively drawn on this micro level social capital to construct this state society synergy. The Rogi Kalyan samiti scheme in the Health department is an example of how this synergy can be harnessed at the micro level.

 

 

   OBJECTIVES:-

1	Improve the management of the hospitals with community participation.
2	Upgradation of Health institution , Mordernisation of  health facilities and purchase of equipments for institution. Effect a continual up gradation of facilities.
3	To ensure discipline & monitor accountability .
4	Provide assured ambulance services for emergencies and  during accidents.
5	To establish public private partnership for betterment of the institution.
6	Maintenance & expansion of  hospital building.
7	To develop the un used extra land of the  hospital  for  commercial purposes as per the guidelines of the state Govt. for strengthening the financial  condition of Rogi Kalyan  Samiti.
8	Increase  community participation
9	Organize training & workshops for staff members.
10	Ensure adequate and safe disposal of hospital wastes
11	Arrange for good quality diet, & drugs and stay arrangements for the relatives of the patients, Ensure equity through provision of free treatment to patients below poverty line.
12	Ensure proper maintenance of Hospital, Wards, Beds, Equipments, cleanliness of premises
13	Monitoring & supervision of  National Health programmes .
14	To obtain loans from banks & financial institutions  for  development & upgradation of  medical facilities in hospitals.

     

    Activities

• To ensure discipline  & monitor accountability.

• Levy user charges in consultation with People’s  representatives.

• Ambulance services for emergency.

• Provide free treatment  to BPL.

• Arrange for good quality diet, & drugs,

• Proper maintenance of Hospital, Wards, Beds, Equipments, cleanliness of premises.

• Organize training & workshops for  staff members

• Waste disposal.

• Up gradation of facilities

• Commercial use of extra  unused land

• Monitoring of National Health programmes.

• Loan from bank for improvement in facility.

 

Structure & composition of Rogi Kalyan  Samiti  -

The Rogi Kalyan samiti (RKS) have two basic attributes:

(A) Simplicity

(B) Flexibility .

Their basic structure is as follows: -

 

The Rogi Kalyan samiti are registered societies and have been set up in all medical colleges, district hospitals, Civil Hospitals, and community health centres, Primary Health Centres, have people's representatives, health functionaries, local district officials, leading members of the community, representatives of the Indian Medical Association, members of the urban local bodies and Panchayat Raj institutions as well as leading donors as their members.

 

Constitution of Rogi Kalyan  Samiti :-

 

Rogi Kalyan  Samiti  have been set up at  various  levels of hospital.

• District hospital        

• Civil Hospital              

• Community Health Center     

• Primary Health Center

 

Institution	No.	Constituted
District Hospital	48	48
Civil Hospital	57	57
CHC	227	227
PHC	1194	830

Rogi Kalyan  Samiti at each level has   two  bodies for its effective functioning: 

1-  General body  &

2-  Executive  body.

 

 

District Hospital

 

General Body

EXECUTIVE  BODY:- 

For managing  day  to day functioning of the Rogi Kalyan  Samiti  Executive committee have been  given certain powers. The  composition of  executive Body is as following:-

Tehsil & Block Level Hospital Rogi Kalyan  Samiti

 

(1) GENERAL BODY

The Community health centers, Civil  hospitals and  other  hospitals at the Tehsil & Block Level come under this  category. The  composition is as following:-

(2) EXECUTIVE  BODY:-  For managing  day  to day functioning of the Rogi Kalyan  Samiti  Executive committee have been  Constituted. The  composition of  executive Body is as following:-

Other Health institutions / Dispensary/PHC

   General Body:-

EXECUTIVE  BODY:-  For managing  day  to day functioning of the Rogi Kalyan  Samiti  Executive committee have been  Constituted. The  composition of  executive Body is as following:-

POWERS  AND RESPONSIBILITIES  OF GENERAL BODY  OF ROGI KALYAN  SAMITI :-

POWERS  AND RESPONSIBILITIES  OF EXECUTIVE COMMITTEE:-

Devolution of powers :-

The government authorised the RKS to manage the existing facilities and assets of the concerned hospital. RKS has been given the freedom for operations, management and investment to meet service requirements.

 

The RKS is empowered to mobilize resources through .Levy of user charges. Commercial use of assets like land of the institution. Donations in cash or kind from the public at large. Allotments / Grants from the government or non government bodies &  Loans from financial institutions.

Levy of user charges

User charges are not only a tool for ensuring efficient use and equitable financing of public services; they also serve as an investment , guide, because consumers' willingness to pay for services is in many  instances the only way in which the benefits of a service can be  ascertained and compared with the cost of providing the service.

 

The guidelines for levying user charges are the folioing: -

 

Charges must be levied for all facilities provided in the hospital including the outdoor patient ticket, pathological tests, indoor beds, specialized treatment, operation etc.

The economically weaker sections of the society and other groups as determined by the government (for example  persons below the poverty line, freedom fighters etc.) would be exempt from the levy. Identification would be based on self-certification. The charges for the general wards would be nominal, while  those for patients in the private wards could be higher. Funds so received would be deposited with the RKS and not in the government exchequer .

 

Implementation -

 

To facilitate a transition from theory to practice, detailed Rules incorporating objectives, membership, qualification of members, functions and powers of the General Body and Executive Committee etc. have been drawn up and published. For day to day supervision and control, hospital management has been decentralized management is now by participation of all the stakeholders. The Executive Committee acts as a watchdog to over see the day to day functioning. Peoples' representatives on the RKS facilitate social audit. The activities of RKS are monitored by the members of the District Government and the Minister Incharge of a district is also the President of district level RKS which ensures effective supervision.

 

Impact -

The first RKS was constituted in 1997 at Indore. Other districts were quick to follow. The success of the early initiatives created a ripple effect. The hospitals covered are all District, Civil Hospitals & Community Health Centres and 830 PHCs. A large number of Primary Health Centres too have now adopted the system. Hospitals have used these funds for renovations of buildings, repair and maintenance of equipments, construction of additional wards and to install newer and better equipment, and furniture.

Developments -

In most hospitals after the introduction of user charges, privatization of various ancillary services, viz. Pathology, sanitation, MIS, Security and Canteen services have been introduced in phased manner. The net gainer is the consumer , as on account of assured turnover, the RKS have been able to negotiate rates which are almost 30% lower than elsewhere. If the number of outdoor / in patients is taken as a measure of customer satisfaction, the experience across the districts varies. Patient out turn has dramatically shoot up in hospitals where there is an effective RKS.

Lessons Learnt -

• Customers are willing to pay for quality medical services in Government Health Institutions.

• Working environment in the Hospitals has improved.

• There is a sense of ownership amongst people vis-à-vis government health institutions.

• Security and sanitation Services have been outsourced successfully.

• Peoples' participation through RKS has enhanced the credibility of the government health institutions.

Strategy for Future -

• The future strategy would be based on the following elements :-

  • Human Resource Development.

  • Need based planning. 

  • Quality of services to meet customer expectations.

  • Improving work environment for optimal performance.

  • Strong monitoring system.

  • Setting verifiable benchmarks.

  • Accreditation of Hospitals.

  • Evaluation of performance through exit surveys-

  • Linking grants, external financial assistance and borrowings to performance.

  • Telemedicine facilities at Indore, Dhar, Mandla & Jabalpur District Hospital (in planning stage)

Income & Expenditure of Rogi Kalyan Samiti  

 

Conclusion :

Madhya Pradesh has done pioneering work in effective local governance by making Panchayati Raj a reality. Local bodies (both Urban and Rural) have been empowered to take decisions on issues which concern them. Significant work has been done towards women's empowerment which is likely to have positive fallout in terms of enlightened mothers and better child care. It is in this context of de-centralised decision making that the concept of Rogi Kalyan Samiti has helped in quick, meaningful and effective decision making at the institutional level be it District Hospitals or Primary Health Centres. Ready availability of funds, enthusiastic participation by people and flexibility in decision making coupled with a sense of oneness amongst the stake holders and identification with the goals of the organisation has made this exercise a success.

As we reflect upon the experience gained during this exercise, we find that the initial effort was concentrated in urban areas. Hence, while we build upon the institution of Rogi Kalyan Samiti in urban areas, the attention in future would be more on rural areas. It is expected that greater people's participation resulting from active Panchayati Raj institutions would enable us to achieve greater success in improving health care delivery in Madhya Pradesh. Decentralization will remain the overarching policy framework for strengthening and improving the hospital system and the service delivery it seeks to provide, through an active participation of all stake holders.