ECHS and its present pitfalls

ECHS Noida
Our Babus have again taken the gullible Services hierarchy for a ride. Our serving soldiers who are ever so keen to do good for their respected Veterans have accepted in true military style to continue to look after us from within their own resources including their welfare funds. A recent report on Peripatetic Check and Review of the ECHS May-Aug 2008 has this amazing Finding:

“Xxxxxxxxx the clientele is very satisfied with the Scheme and considers it to be a boon from the Govt, which was long awaited. IT IS CONSIDERED THAT THE SCHEME WOULD NOT HAVE BEEN SO SUCCESSFUL UNTIL THE THREE SERVICES HAD NOT SUPPORTED WITH THE FOLLOWING”: - (SIC)

Additional Medical Officers and Specialists from welfare funds.

Huge clinical manpower which includes both the serving doctors and hired manpower from Regimental funds.

Patient comfort by providing amenities from its regimental funds and creation of additional space at the Polyclinics.

Does all this sound even remotely like a sincere effort to reduce the load on the Services medical facilities? Just one small example of how expecting the Armed Forces to provide ECHS cover from within existing resources man power and funds affects the system will be enough. Currently, after a reimbursement bill has been passed the cheque has to be collected by the ESM personally from Station HQs Delhi Cantt. Reason: The Station HQs are not authorised funds and therefore service labels to stick on the envelopes forwarding the cheques to the individuals, which have to be sent through the mail.

Whereas we have generally got used to being taken for a ride by our worthy politicians and babus the question that needs an answer is- how was the existing structure of the ECHS conceived? It does not take a genius to comprehend that such multiple channels of command will be a non-starter. Is it any surprise that no matter how hard the MD ECHS tries he will not be able to push Station HQs Area HQS etc who neither report to him nor have dedicated staff for ECHS purposes. The MD ECHS and the Regional Centres lack authority for exercise of functional controls over the Polyclinics and also the Station HQS controlling the polyclinics. No wonder good hospitals refuse to waste their time chasing their claims and we are left with poor quality health care.

The Army has adequate experience in such Schemes in the shape of AGIF, AWES and AWHO. Though these schemes are pure Army schemes without Government resources did we need to make a hash of the Command and Control structure of the ECHS. Unified Command is a well-known and recognised tenet of management within the Armed forces. MD AGIF manages all AGIF functions, MD AWHO manages all AWHO functions, then why the mess in the ECHS. Is it any surprise that things are not settling down even five years after inception of the Scheme?

As I said at the beginning the purpose of the ECHS was to reduce the Ex Servicemen load on Services hospitals and resources. Somewhere along the line this main thought has been lost sight of and the ECHS has fallen prey to the standard “building of its own empire” syndrome. We therefore have a recommendation from the Review Committee, which states: -

Reduce referrals to civil empanelled facilities by augmenting Polyclinic/Service Hospital facilities by providing specialist cover within the authorised medical establishment
Improve the system of drugs procurement and management by improving the policy for drug procurements by DGAFMS and Polyclinics and by authorising contractual manpower for better drug management.

The ECHS in the absence of clarity of a strategic vision, which envisaged outsourcing of ESM patients to existing civil facilities, has embarked on a course of creating more polyclinics, more dependence on Armed Forces infrastructure and funds without insisting that the Govt ensure the desired standards. The report on Peripatetic Check and Review of The ECHS says it all in just one sentence “IT IS CONSIDERED THAT THE SCHEME WOULD NOT HAVE BEEN SO SUCCESSFUL UNTIL THE THREE SERVICES HAD NOT SUPPORTED WITH THE FOLLOWING.”

This is the philosophy that has prompted the ECHS to propose a shift of the Noida Polyclinic from its present location to Sector 52 in land owned by the Coast Guard (Defence Land) so as to raise a more spacious Polyclinic. The comfort and convenience of ESM “Comes Last Always and Every Time”. I am strongly of the opinion that in Noida where there is such a large concentration of ESM the Arun Vihar RWA must get actively involved in all ECHS matters not as an authority but in a supportive role.

Improvement in the functioning of the ECHS is a continuing subject. This article is intended to make ESM aware so that they can demand what is justifiably theirs by right; and to make the ECHS more responsive to ESM requirements. To summarise what is required is as follows: -

Refer patients to empanelled hospitals of the patient’s choice anywhere in the NCR.

Permit empanelled hospitals to undertake “out patient” treatment in emergencies to be determined by the Dr at the empanelled hospital.

Appointments in RR to be arranged by the OIC Polyclinic. A methodology can quite easily be worked out.

After investigation reports to be collected by OIC Polyclinic from the RR.

All paperwork required after emergency “in patient” and “outpatient treatment” at empanelled hospitals to be handled between OIC Polyclinic and the empanelled hospital.

OIC Polyclinic should keep a track of all individual reimbursement claims generated after emergency treatment at non-empanelled facilities, which should be cleared at various levels in a set time frame. Presently the ESM has to do the chasing of the claim after it leaves the Polyclinic.

Reimbursement claims of individuals be sent to the Noida polyclinic from where they can be collected.

The Polyclinic must continue in Arun Vihar with the RWA getting more actively involved in its day-to-day problems without becoming a hindrance.

The Polyclinic should be the one point contact for ESM. There should be no need for him to contact anybody else in the ECHS chain.

Make arrangements despite staffing problems to ensure early clearance of pending bills of empanelled hospitals. This is the reason why all the good hospitals have delinked from the Scheme. An all out effort needs to be made to get the best hospitals on the ECHS panel.

Reference to empanelled hospitals should be the norm. More and more dependence on Army Hospitals is violative of the very basis on which the ECHS was created.

FINALLY AND MOST IMPORTANTLY THE ORGANISATIONAL STRUCTURE REQURES A VERY SERIOUS RELOOK. UNITY OF COMMAND IS A MUST. THE PRESENT FRAGMENTED AND FRACTURED STRUCTURE WILL COLLAPSE. IT IS ALREADY BEING CORRUPTED SINCE ARMY PERSONNEL AT STATION– SUBAREA– AREA AND COMMAND HQS ARE NOW DEALING WITH CIVIL HOSPITALS AND NUMEROUS CIVIL AGENCIES FOR EMPANELLMENT/ PASSAGE OF BILLS/ PROCUREMENT OF MEDICAL EQUIPMENT AND STORES ON A DAY-TO-DAY BASIS. IN ANY CASE THEY ARE DOING ECHS WORK IN ADDITION TO THEIR OWN CHARTER WITHOUT ADDITIONAL MANPOWER AND WITHOUT ANY INCENTIVE. THE MD ECHS IS NOT IN THEIR CHAIN OF COMMAND AND HAS NO CONTROL ON THEIR FUNCTIONING.

Brig SC Kuthiala (Retd)

Full article click:ECHS by Brig SC Kuthiala (RETD)

We thank Brig SC Kuthiala for his indepth analysis of the functioning of ECHS. He has amply described the mindset of bureaucrats who have taken the veterans for a royal ride. He has also given us valuable suggestions for improving the functional efficiency of the system. Kindly click the above link to read his full article as only extract has been posted here.