Wednesday 30 May 2012

वे डॉक्टर नहीं रहना चाहते !!!!!!

ठीक है कि वे डॉक्टर नहीं रहना चाहते
योजना आयोग के मुताबिक, देशमें छह लाखडॉक्टरों, दस लाखनर्सों और दो लाखडेंटल सर्जनों की कमी है। पिछले एक साल में एक दर्जन वरिष्ठ प्रोफेसर एम्स छोड़ चुके हैं और अनेक वरिष्ठ प्रोफेसर रिटायर होने वाले हैं।
इस साल की सिविल सर्विसेज परीक्षा में एम्स से डॉक्टरी की पढ़ाई कर चुकीं शीना अग्रवाल अव्वल आई हैं। कश्मीर घाटी से सफल हुए छह उम्मीदवारों में से पांच डॉक्टरी की पढ़ाई पूरी कर आए हैं। डॉक्टर आखिर आईएएस क्यों बनना चाहते हैं? कुछ साल पहले सफल हुए केरल के डॉ. समीरन ने डॉक्टर की सरकारी नौकरी के दौरान महसूस किया कि स्वास्थ्य के मुद्दे वास्तविक तौर पर सिर्फ स्वास्थ्य के मुद्दों तक ही सिमटे नहीं होते। इसी को ध्यान में रखकर उन्होंने चिकित्सा के बजाय प्रशासन का रास्ता पकड़ा।
बात 1982 की है, जब इंदिरा गांधी से मिलने नवनियुक्त आईएएस अधिकारी आए हुए थे। एक एक अधिकारी का परिचय प्राप्त करते हुए जब वह आगे बढ़ रही थीं, तो एक मेडिकल डॉक्टर आईएएस की बात सुनकर उन्होंने पूछा, आपको इस सर्विस में आने की क्या जरूरत पड़ी? युवा डॉक्टर आईएएस ने जवाब दिया कि एक सरकारी मेडिकल अफसर से सिविल सर्जन बनने में मुझे बीस साल लगेंगे और फिर भी डिस्ट्रिक्ट कलक्टर को रिपोर्ट करना होगा। आईएएस बनकर मैं महज चार साल में डिस्ट्रिक्ट कलक्टर बन जाऊंगा।
एम्स के वरिष्ठ प्रोफेसर डॉ. शक्ति गुप्ता ने कुछ साल पहले एक अध्ययन प्रकाशित किया था कि एम्स में साढ़े पांच साल की एमबीबीएस की पढ़ाई पूरी करवाने में प्रति छात्र लगभग एक करोड़ सत्तर लाख रुपये खर्च होते हैं। तब यह तथ्य भी सामने आया कि औसतन तिरेपन फीसदी छात्र एम्स की पढ़ाई के बाद उच्च अध्ययन या ज्यादा पैसा कमाने के लिए दूसरे देशों में चले जाते हैं। यही हाल आईआईटी का है। लंबे समय तक मद्रास, आईआईटी के निदेशक रहे डॉ. इंदिरेशन ने अपने एक लेख में हिसाब लगाया था कि आईआईटी से एक विद्यार्थी को पढ़ाई कराने में बीस से तीस लाख रुपये का कैपिटल खर्च आता है और उस समय के हिसाब से दो लाख रुपये का रनिंग खर्च।
करीब दस साल पहले प्रणब मुखर्जी की अध्यक्षता में एक संसदीय समिति बनी थी, जिसने सुझाव दिया था कि सिविल सेवा परीक्षाओं में सम्मिलित होने से इंजीनियरों और डाक्टरों को वंचित किया जाना चाहिए, क्योंकि वे प्रचुर सबसिडी प्राप्त विशेषज्ञ शिक्षा प्राप्त करते हैं, पर देश को उनकी विशेषज्ञता का कोई लाभ नहीं मिलता। लेकिन इस सिफारिश को कूड़े के ढेर पर फेंक दिया गया। गौरतलब है कि जापान और फ्रांस जैसे देशों ने अपने यहां नौकरशाही में प्रोफेशनल डिग्रीधारियों को प्रतिबंधित कर रखा है।
योजना आयोग के मुताबिक, भारत में छह लाख डॉक्टरों, दस लाख नर्सों और दो लाख डेंटल सर्जनों की कमी है। इस रिपोर्ट के अनुसार बिहार में अभी एक करोड़ पंद्रह लाख, उत्तर प्रदेश में पंचानबे लाख, मध्य प्रदेश में तिहत्तर लाख और राजस्थान में अड़सठ लाख की आबादी पर एक मेडिकल कॉलेज है, जबकि केरल में सिर्फ पंद्रह लाख, कर्नाटक में सोलह लाख और तमिलनाडु में उन्नीस लाख की आबादी पर एक मेडिकल कॉलेज कार्यरत है। एम्स की आम लोगों और मेडिकल विशेषज्ञों के बीच जो भी प्रतिष्ठा हो, सरकारी नीतियों और राजनेताओं और नौकरशाहों के अत्यधिक हस्तक्षेप ने इसकी चमक फीकी करने में कोई कसर नहीं छोड़ी। स्वास्थ्य संबंधी ढुलमुल नीतियों ने भी एम्स से डॉक्टरों के पलायन का मार्ग प्रशस्त किया। पिछले एक साल में एक दर्जन वरिष्ठ प्रोफेसरों ने एम्स को अलविदा कह दिया और अगले तीन वर्षों में करीब चार दर्जन वरिष्ठ प्रोफेसर रिटायर होने जा रहे हैं। यानी चिकित्सा के क्षेत्र में हमारी राष्ट्रीय चुनौतियां अभी थमने वाली नहीं हैं।

Thursday 24 May 2012

What are the cases that should be regarded as medico legal?


The following cases must be labeled as medicolegal by the treating doctor and medicolegal report should be prepared for further legal investigation
All injury/hurt cases, circumstances of which suggest commission of offence by someone
All traffic vehicular, railways, aeroplane, ship, boat, factory, construction site or other unnatural accidents
Self–inflicted injuries/attempted suicide
Cases of criminal abortion
Accidents where there is likelihood of death or grievous hurt
All cases of suspected or evident poisoning
Suspected or evident homicide, suicide including attempted
All burn injuries, whatever the cause of burn
All suspected or evident sexual assaults
All suspected or evident criminal abortion
Unconscious cases where the cause is not natural or not clear
Cases referred by Courts for age estimation
Cases brought dead with improper medical history
Dead on arrival cases or patients who die shortly after being brought to the hospital before a definite diagnosis can be made
Patients dying suddenly after parenteral administration of a drug or medication
Patient falling down or any mishap in the Hospital, sustaining injury in the Hospital
Death on the operation table
Unexplained death after surgery or interventional procedure
Unexplained ICU death
Patient treated and then referred from a private hospital or other Government hospital with complications of surgery or delivery or bleeding, where the cause of death is unexplained.
Relatives of the patient assault the treating doctor or other staff of the hospital.
Any other case not falling under the above mentioned category but has legal implications like medical examination of arrested accused without consent of person.
In case of death of a medicolegal case, the treating doctor has to only handover the body to the concerned police officer with written recommendation for medicolegal (Forensic) autopsy in final death summary/discharge report and a receipt must be obtained for record.

Sunday 20 May 2012

Financial Management, Internal Control & Accounting System at State/District Health Societies & Blocks /RCH Societies




  
                     GUIDING PRINCIPLES OF FINANCIAL MANAGEMENT

5.1     The overall internal control framework of the NRHM programme is governed by the provisions of this manual read together with procurement manual and prescribed financial limits/norms issued by various pogrammes of Ministry of Health & Family Welfare and various programme guidelines such as Janani Suraksha Yojana, MNGO guidelines and ASHA guidelines etc.

5.2     Any officer of a State Health Society or of a District Health Society, who is authorized to incur expenditure or draws money out of the RCH-II funds (Bank A/c) for disbursement, should treat himself as a trustee of the funds of such society or District Unit and would therefore, manage all types of financial affairs in the capacity of a sincere Executive trustee.

5.3     The officer, who is authorized to draw and incur expenditure out of a State Health Society or a District Health Societyfund, is expected to exercise same vigilance, which a man of ordinary prudence exercises while incurring his own money. He should keep in mind that:-

i)                   Funds should not be drawn if they are not required for immediate   disbursement.
ii)                Funds should not be utilized directly or indirectly on himself or on any family member or relative of the officers who operate the funds of the society or a unit for the time being.
iii)              The Mission Director at State Health Society and District Programme officer(s) at District Health Society level will ensure, with the help and assistance of State Finance Manager, State Accounts Manager respectively, that an efficient system of internal financial control is introduced, for which they should visit District Health Society & Programme implementing Agencies frequently & make instant inspections/examinations of Cash Book, Bank Pass Book, Ledgers & some vouchers of more than Rs.5,000/- value and satisfy themselves that all of these are being maintained properly. Similarly, District officials (including DPMU staff) should make regular visits to the sub-district levels to ensure that efficient and sound financial system is in place. During the visit, they may verify the implementation status of various programmes as per the checklist. RNTCP and IDSP already have a checklist for the verification purpose on the field visits. 
iv)              Officers authorized to incur expenditure must ensure that financial order and strict economy are enforced at every step and see that all-relevant financial rules, orders, directions and instructions are observed.
v)                It should be seen that not only the total expenditure is kept within the limits of the budget provision but also that the funds allotted/transferred, are spent strictly in the interest and service of the programme and upon the objects for which provisions have been sanctioned.
vi)              He will also see that items of expenditure are of obvious necessity and are at fair and reasonable rates, sanction of the competent authority obtained and calculations are correct.
vii)           In order to exercise proper financial control, he should keep himself closely acquainted with the progress of receipts, expenditure, commitments or liabilities incurred but not paid.

CHECKS TO BE EXERCISED BEFORE WITHDRAWAL & DISBURSEMENT OF FUNDS


5.4     Before authenticating a cheque for any payment/disbursement, the cheque drawing officer, in this regard, shall ensure that:
i)             There is a proper and formal statement of claim (Bill) or invoice through which payments have been demanded by the concerned person or party or firm.
ii)          Invoice must be marked “Passed for Payment” on its face by competent authority. In case of advance adjustments, it should be marked “Passed for Adjustments”.
iii)        That the purchases made or services received are according to the approved plan and the claimant is entitled to get it.
iv)        That the particulars of the claim i.e. rates, calculations, net payable amount etc. have been examined/checked by the Accountant or by an authorized accounts person and have also been entered in appropriate stock/store register wherever necessary and certification on this account has been made on the bill/claim itself by an authorized officer.
v)          A competent sanction to incur expenditure is attached with the claim.
vi)        ADVANCES:
§  In case of advances payments, it must be ensured that all earlier advances to the same person/party and for the same purpose have been settled/adjusted. No advances should be made to a person/party if an advance is already pending for settlement for the same purpose.
§  All the advances should be settled within a maximum period of 90 days. All the advances should be entered in Advance Register as per APPENDIX 10. Settlement of advances should be tracked as per Advance Tracking Register as per Appendix 11). Age wise analysis of unsettled advances should be prepared and periodically be reviewed by Programme Officers.
§  For settlement of long pending advances lying with various institutions/organizations, special drive may be undertaken by forming special teams and deputing them to these institutions.
vi) AUTHORIZATIONS & PAYMENTS FOR CONTRACTS/AGREEMENTS:
§  Payments to be made in accordance with the terms and conditions of the contract/agreement including compliance with the conditions relating to performance guarantee and bank guarantee.
§  Goods receiving officers to certify the quality and quantity of the goods received.
§  Evidence to show the delivery of goods and services at the agreed time and place of delivery should be obtained.

5.5     POST PAYMENTS INTERNAL CONTROLS:
§  Paid invoice and supporting documents must be defaced with the seal of “Paid & Cancelled”. The reference of cheque vide which the payment made is to be recorded on invoice.
§  All the paid vouchers must be serially numbered and maintained box file.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
5.6     PROCEDURE FOR UTILISATION OF FUNDS

i)                   The Society funds shall be drawn through cheques and/or bank drafts. All payments to the maximum extent possible should be made by cheques only. Cash payment should be discouraged at all levels.
ii)                Any payment above Rs 5000/- must necessarily be made through crossed Account payee cheques only.

iii)              All cheques shall be signed by at least two signatories as authorized by the Governing/Executive body of the Society in line with defined guidelines . Similar control mechanisms should be ensured in case of electronic transfer of funds.

           
5.7     PREPARATION OF CHEQUES

i)                   All the cheques shall be entered in the Cheque issue register before they are submitted for signatures, indicating its number, amount, name of the person or party, purpose  and date of issue, etc.
ii)                Cheque books, new or used or under used shall be kept in the personal custody of one of the officer who are authorized to put their signature on the cheques.
iii)              Acknowledgement of a cheque shall be obtained from the payee (receiver) in the prescribed format.
iv)              CASH WITHDRWAL: Signatures with date shall be obtained in the cheque issue Register from the Cashier/Accountant for each cheque, which is endorsed in his favour or handed over to him for obtaining cash payment from the bank.
v)                All persons handling cash and keeping valuable stores should be required to provide Fidelity Insurance in favour of the State Health Society of not less than Rs.1,00,000/- from a Nationalized Insurance Company or Bank against which monthly security allowance will be paid on the basis of 1% of the ‘Fidelity Insurance’ value per month.

5.8     WRITING OF CASH BOOK
i)                   All payments which are received in the State Health Society or in a District Health Society and at Block CHC/PHC, either in cash or through cheques/bank drafts/money orders/bankers cheque etc. shall be first entered in the prescribed register and then entries in the cash book shall be made, on the same day. Likewise all payments/disbursements shall be entered in the cash book on the day of the payment.
ii)                Receipts shall be issued, for the cash/bank Drafts/Banker cheque and money orders on its entry in the prescribed register, signed either by one of the fund operator or by an authorized officer.
iii)              Cash book shall be written on daily basis and closed on the same day and put up for checking & authentication to one of the cheque signing officer as decided by the chairperson of the Executive Committee of a State/District Health Society.
iv)              Cash book should be closed daily and if no transactions have taken place in a day/s the entry "No Transaction" has to be noted in the cash book on that day/s in red ink and balances are to be carried over to next day.
v)                Cash balance, more than Rs.10,000/-, should be avoided to be kept in office, as far as possible.
vi)              Escort should be provided to the cashier when he is required to carry the amount more than Rs.10,000/- from the bank at a time. Cashier should be provided vehicle to obtain heavy cash form the Bank.
vii)           The Cash book is the principal record of all money transactions taken place every day and all other registers are subsidiary. It should be maintained on the basis of double entry system as per format appended with the manual.
viii)         Each entry of receipt and expenditure should be descriptive but brief in nature. Each voucher should be assigned a serial number and Ledger Folio number, which should be noted against each entry in the cash book.
ix)              All cash/cheques/Demand Drafts etc. received should be deposited into bank as far as possible on the same day itself, otherwise on the next working day positively. If any cash remains in office on any day it should be kept in the cash chest/vault which should have double lock system. The cash kept in the chest should be deposited in the bank account on the next day and the entry in the cash book should be verified physically by the authorized officer.
x)                Over writings should be avoided and corrections, if any, should be attested by the authorized officer under his dated initials.
xi)              While making payments through cheque, its number should invariably be noted in the cash book for cross checking.
xii)           Format of Cash Book to be maintained at State Health Society and District Health Societies and Block Units .

VERIFICATION OF CASH BALANCE
         
5.9     The contents of the cash chest/cash box should be verified by the SFM/SAM at State level, by DAM at District Level and Block Accountant at Block level and Programme Officer at Health Society level at least once in a month at the close of the month or on the first day (immediately after opening of Office) of the next month and the amount will be compared with the cash book balance shown in the Cash Book.
         
5.10   The result of verification should be recorded in the cash book each time as under: “Certified that Cash Balance checked and found correct”. In case the cash balance is found to be less or in excess then the balance shown in the cash book, the fact should be recorded in the cash book and a formal report should also be submitted to the next higher authority for further necessary action. 

5.11   A cash balance certificate shall be obtained at the end of each year as per the format provided in appendix.

MAINTAINING BOOKS OF ACCOUNT
         
5.12   Complete and correct accounts in respect of each monetary transaction occurring at State Health Societys or at District RCH Societies shall be maintained through prescribed Books of Account including Registers as indicated below:

(a)        Cash book with cash & Bank columns.
(b)       Petty cash book
(c)        Cheque issue register
(d)       Register of Bank drafts and Cheques received
(e)        Bank Pass Book/Bank Statement
(f)         Register of Bank drafts/Cheques dispatched.
(g)        Ledger (in line with the Chart of Accounts of various programmes)
(h)       Journal
(i)          Registers for Temporary advances as below
·        Advance to the staff (Control Account)
·        Advances to the Contractors/suppliers/CHCs/PHCs. (Control Account)
·        TA/DA advance (Control Account)
(j)          Salary Register
(k) Fixed Asset Register:
§  Machinery & Equipment's
§  Civil Works,
§  Mobile Medical Units, ambulances etc.
(l)          Stock Registers for: -
·        Furniture & other non-consumable articles.
·        Register for drugs & medicines.
·        Register of consumable articles
(m)     Register of advances to NGOs and other Voluntary Agencies implementing NRHM.
(n)       Dispatch Register

N.B.  Any other book of accounts and resisters, which may be considered necessary for the day-to-day work of the State/District Health Society, the same may be maintained.

5.13   The State Health Society and its District Health Society shall maintain Dead Stock Registers, separately for machinery & equipment's and other non-consumable articles and  shall also arrange for physical verification of stores articles of permanent or long duration nature, at least once a year in the month of April. If any item of permanent nature is purchased at CHC/PHC level, entry in the concerned Register of District RCH Society shall be made on the basis of the voucher or bill etc.
         
5.14   All functionaries should ensure that only actual expenditure incurred is treated as expenditure and not the normative costs in accounting. Therefore, fund released by the State Health Society to District Health Societies or to any other implementing agency by the District Health Society such as CHC/PHC etc. shall, initially be classified as Advance and the same is indicated as such in the books of accounts. The advances shall be adjusted based on the expenditure statement/utilization certificate received from the Advancee.  Advance, if not actually spent or if spent but accounts not settled should be shown as advance and not as expenditure and all such outstanding/unsettled advances should be shown in the SoEs separately.


5.15   The audit will verify the status of settlement of all advances.

MIS-CLASSIFICATION OF EXPENDITURE

5.16   If any item of receipt or payment (cheque), belongs to one head of account has been wrongly classified under different head, the error can be corrected by making an adjustment entry in the journal and posting of the same in the related ledger account heads. It should be noted that such corrections in the cash book or ledgers can be made before the accounts of a financial year are closed to prepare annual accounts for audit purposes.

JOURNAL

5.17   Journal is one of the important account book but its use is restricted to recording adjustment entries only other than cash transactions. Vouchers shall support each adjustment entry passed through a Journal. Brief narration of each entry shall be given in the voucher and it should be signed by the Cheque drawing officer. The Finance/Accounts Manager at Health Society will check each such entry of the Journal with the Journal voucher and other subsidiary vouchers and put dated initials against the entries checked.

LEDGER

5.18   The ledger is also an important register in which all transactions recorded in the cash book or journals are classified under different heads of accounts.

5.19   The ledger should be kept in the standard form. Separate pages are to be opened for each item of expenditure. The ledger accounts shall be arranged and grouped in such a manner that the desired information is promptly secured.

5.20   Every ledger account is divided into two sides, the left-hand side being the "debit side" and the right hand side the "credit side". All items of debits and credits of the cash book and journal shall, invariably be posted on the same day in respective ledger accounts. Daily totals should be made, shown in the inner column and the progressive totals shown, wherever necessary in the outer (balance) column.

5.21   All the ledger accounts shall be closed at the end of the month. Totals would also be made in the classified abstract. Monthly totals of various ledger accounts shall then be tallied with the totals of classified abstract and discrepancy, if any, will be rectified and reconciled.

5.22   Bank account shall be posted from the daily totals of cheques issued and challans/remittances (deposited) made into the Bank.

RECEIPT AND PAYMENT STATEMENT

5.23   Monthly account of receipts and payments shall be prepared immediately after closing of the accounts for the month but not later then 5th of the next month.

BANK RECONCILIATION STATEMENT

5.24   Bank reconciliation statement will be prepared on monthly basis by reconciling the cash book and Bank Pass Book/Bank Statement by 10th day of the following month.  Bank Pass Book will be sent to the bank on weekly basis for making up-to-date entries of credits and debits in the month.  Any discrepancy will be rectified and difference explained in the bank reconciliation statement as per the format provided .
         
ADVANCE REGISTER

5.25   All advances sanctioned to an officer of State Health Society or to the District Programme Management Unit or to the In-charge Medical Officer of a CHC or PHC or to any other official of the above institutions and also to any non-government organization, shall be entered in the Advance Register (format given in  immediately after the advance amount/ cheque is given to the advancee. Any advance remaining unadjusted at the year end may be adjusted in the SoE for the last quarter of the year. However, the procedure for adjustment/settlement/refund of advances and their depiction in the Advance Register may continue as prescribed. The audit by Chartered Accountant would ensure the compliance and also highlight the advances pending adjustment for long period.  For the purpose of facilitating proper tracking of advances and their settlement, an Advance Tracking Register should be maintained, at all the levels from where the advances are given, in the Format given.

REGISTER OF FIXED ASSETS

5.26   Each State/District Society shall maintain Stock Registers for the articles or item of permanent or of non-consumable nature indicating the details of such assets e.g. furniture, fixtures, equipment's, machinery, instruments, vehicles, computer systems etc. purchased during the programme period. Such register is also called as Register of permanent (nature) articles or Dead Stock register. Annual physical verification shall be carried out in the month of April every year. This register shall be maintained in the format given.

5.27   Only those articles, as mentioned in the above para, will be treated as assets of the society which are procured, used and installed in the Office of the Society and will form part of the core asset of the society. Formal tracking as per the requirements of the Asset Register for the entire life of the asset will be done by the society.    

5.28   All other assets which are purchased by the society and subsequently handed over to the Office of Health & Family Welfare/Family Welfare Stores/CMOs/PHCs/CHCs, etc. will be shown as transferred to such entities in the Asset Register and no further tracking about the life of the asset will be required. However, a certificate from the receiving entity will be required to be kept in the asset register with contra- entry in the ‘Location/Under custody’ column of the Asset Register .

RE-APPROPRIATION OF FUNDS

5.29     Any changes in the approved PIP/AWP may be discussed during the quarterly and annual reviews and implemented by mutual consent. The States/UTs may amend their approved AWP within 10% of any of the sub item(s) so as to have flexibility in inter-component use of funds without affecting the overall outlay approved for the State/UT for the year. Activity-wise performance evaluation will then be synchronized with the revised work plan. In all such cases FMG, GOI will necessarily be informed of this revision.

COMPUTERISATION OF ACCOUNTS

 

5.30   It is desirable that maintenance of accounts at the State/UT Health Societies as well as at District Health Societies is computerized so that the account statements can be prepared accurately and promptly with least efforts and time. State should maintain accounts in Tally software as the trained personnel in this software are widely available. 


5.31   Even if the accounts are maintained in computerized form in Tally, at least the Cash Book should be maintained manually as well.  The print out of daily, weekly or monthly statements may also be serially kept in file.


what i think to improve Health system in Uttarakhand



izns’k ds ioZrh; {ks=ksa esa fLFkr jktdh; fpfdRlky;ksa esa fu;qDr fpfdRldksa dks izkbosV izSfDVl dh vuqefr nsus ds lEcU/k esaA
    
     izns’k esa fLFkr Js.kh 1]2]3] o 4 esa fpfUgr fpfdRlky;ksa ftudk Lrj ,y&1] ,y&2 ,y&3  gSa  ¼crZeku esa ,y&1 esa 534] ,y&2 esa 66] ,oa ,y&3 esa 124 bl izdkj dqy 724 fpfdRlky; LFkkfir gSa½  bu fpfdRlky;ksa esa fu;qDr fpfdRlkf/kdkfj;ksa dks izkbosV iSzfDVl djus ds lEcU/k esa fuEu fcUnq izLrkfor gSaA
  1-     bu fpfdRlky;ksa esa fu;qDr fpfdRlkf/kdkjh iwoZ dh HkkWafr vius lHkh of.kZr nkf;Roksa dk fuoZgu djrs jgsxsaA
2-     fpfdRlky; dk le; iw.kZ gksus ds mijkUr lka; dky esa os fpfdRlky; Hkou esa gh izkbosV iSzfDVl djus ds fy, vf/kd`r gksxsaA
3-     ftu fpfdRlky;ksa esa fpfdRlk izcU/k lfefr cuh gS mlesa ijke’kZ ‘kqYd fu/kkZfjr djus dk vf/kdkj lfefr dks gksxk vU; fpfdRlky;ksa esa ijke’kZ ‘kqYd fu/kkZj.k djus dk vf/kdkj tuin ds eq[; fpfdRlkf/kdkjh dk gksxkA bu nksuksa izdkj ds fpfdRlky;ksa esa vf/kdre ijke’kZ ‘kqYd ` 50@& gksxkA
4-     izkbosV iSzfDVl jktdh; fpfdRlky; ds Hkou ij djus ds cnys mUgsa izfrekg 500@& :i;s jktdh; dks”k esa tek djuk gksxkA
5-     ijke’kZ ds mijkUr thou j{kd nokb;kWa ,oa vfr vko’;d vU; nokb;kWa fu;ekuqlkj fpfdRlky; ls gh fu’kqYd nh tk;sxh ,oa vU; ijh{k.k vxys fnol esa fu;r ;wtj pktZ tek djus ij fpfdRlky; ls djk;s tk;sxsaA
6-     ;fn jksxh fpfdRld }kjk ijkef’kZr vkS”kf/k;kWa@ijh{k.k cktkj ls djuk pkgrk gS rks jksxh dks mDr vkS”kf/k;kWa ds ewY; dh izfriwfrZ fu;ekuqlkj dh tk;sxhA
7-     izkbosV iSzfDVl djus gsrq vks0ih0Mh0 dk ipkZ fpfdRlky; ds ipsZ ls vyx jax dk gksxk ,oa  ipkZ fu’kqYd cusxkA ;g ipkZ dsoy ,d lIrkg ds fy, ekU; gksxkA
8-     izkbosV iSzfDVl ls ekg esa ns[ks x;s jksfx;ksa dh lwpuk lEcfU/kr fpfdRlkf/kdkjh vius fu;a=d vf/kdkjh dks izsf”kr djsxkA
9-     lEcfU/kr fpfdRlkf/kdkfj;ksa dks iwoZ dh HkkWafr fu;ekuqlkj iSzfDVl cUnh HkRrk ns; gksxkA
10-   mDr Js.kh ds fpfdRlky;ksa esa fu;qDr lafonk ,yksiSfFkd ,oa nUr fpfdRld dks Hkh izkbosV iSzfDVl mijksDr ‘krksZ ds lkFk vuqeU; gksxkA
11-   mDr lka;dkyhu le; esa ;fn dksbZ jksxh viuk ijh{k.k viuh bPNkuqlkj rRdky djkuk pkgrk gS rks og ;wtj pktZ ls 25 izfr’kr vf/kd Qhl tek dj viuh tkap djk ldrk gSA
12-   vkj0,l0ch0okbZ0] LekVZ dkMZ ;k vU; fdlh chek ;kstuk ls vkPNkfnr jksfx;ksa dks ;g lqfo/kk miyC/k ugha gksxh vU;Fkk mUgsa Hkh fu;fer ijke’kZ ‘kqYd nsuk gksxkA
13-   jksxh ds izcU/ku ds fy, ftEesnkj VSDuhf’k;u] o vU; iSjkesfMdy LVkQ dks lEcfU/kr fpfdRlky; ds fpfdRlkf/kdkjh vius ekg Hkj ds vftZr ‘kqYd esa ls ekuns; nsxsaA
14-   ;fn jksxh dks vUrZjax foHkkx esa HkrhZ djus dh vko’;drk gksrh gS rks jksxh ls izLrkfor ;wtj pktZ ds vuqlkj gh ‘kqYd fy;k tk;sxkA

Saturday 19 May 2012

A vision for the public health sector in Uttarakhand


A vision for the public health sector in Uttarakhand
Rajive K. Dikshit, MD, FCCM, MPH
PUBLIC HEALTH is one of the most important areas of human development and sadly one of the most neglected in modern India. Even in Uttarakhand, with its unique distinction of achievements in the health sector, there are huge shortcomings. One of the most important pillars of the system, that is the general health service, is now in a state of flux and disrepair. In the face of challenges mounted on the curative side by well-equipped private institutions and on the preventive side by uncontrolled epidemics, the system is reeling and its record is abysmal. I have based my observations depending on scenario in one State, Uttarakhand, but it is no different when it comes to other States; it is actually worse.
Most of our district and taluk hospitals are motley collections of century old structures and more modern blocks added with no overall plan. None of these buildings are properly planned to house a health care institution. Health Personnel are mostly experienced and well trained but lack motivation and incentive. Their deployment is unscientific and done in knee jerk fashion. Corruption is endemic.
Primary health care continues to focus on family planning and immunization and other urgent issues like epidemic control and non-communicable diseases receive little attention except when there is an emergency.
I would now outline briefly what I believe should be the ultimate aim or Vision 2020, as the cliché puts it.
Taluk or sub-divisional hospitals should be provided with all basic specialties. This would entail a modern operation theatre; post surgical ICU, medical ICU and a full fledged anesthesia wing. "Latest" equipment such as endoscope, arthroscopy, etc., should be available. Laboratory services to perform all but rare tests should be there round the clock. Existing structures should be abandoned to construct a single spacious block which will house all specialties and will have airy comfortable waiting areas and consultation rooms, computerized OPD registration, polite staff to guide patients to various services, and sufficient greenery inside and outside to promote holistic healing. In addition to these, district hospitals should provide sub-specialty services including neurology, cardiology, and gastroenterology, etc., apart from separate ICUs for cardiac cases. Waste disposal should follow established guidelines. Material management and medical records should be computerized.
Control of the hospitals should be ceded to hospital management committees set up with representatives from local governments, doctors, and NGOs. Private practice should be banned after providing 50 per cent of total emoluments as non-practicing allowance. Vigilance cells should be set up to investigate allegations of corruption within 48 hours. Doctors should be given 5-year terms to ensure continuity of care and reduce corruption in transfers.
Minimum acceptable standards at primary, secondary and tertiary levels should be codified and a Health Regulatory Authority set up. This body should be entrusted with regulatory and recommendatory powers in the sector including private sector.
In the primary health care sector, while continuing to provide demand based services in the Immunization and Family Welfare sector, field staff should be retrained in trauma care, accident prevention, and supported with sufficient infrastructure for accident transport and trauma care. They should also be trained to provide information on non-communicable diseases like diabetes. Epidemic reporting and control should be reorganized by computerizing all field offices like sub centers and primary health centers and ensuring paperless and rapid reporting.
Resource generation
I shall briefly outline a few non-conventional but practical proposals for resource generation:
Reasonable user fees should be charged after a political consensus on the issue. This should be tied to concrete plans to improve the system.
Real estate rendered surplus after scientific redesigning of hospitals should be commercially used. Funds accrued should be ploughed into a separate fund managed by the hospital management committee. A trust can be formed to reinvest part of this money in government securities. Part should be directly invested in the hospital.
Pay clinics providing sub-specialty services and other high end services should attract richer clientele who can cross-subsidies poor patients.
Ancillary laboratory services can also operate commercially, to outside patients.
Governments can float Health Development Finance Corporations to collect deposits and provide loans to private health sector. The profits should be ploughed back into a dedicated fund to improve health systems.
The health insurance scheme already announced should be effectively implemented.
A health cess should be imposed on  liquor  & Tobacco Product sold, the proceeds of which should again be ploughed into the dedicated health fund.