Newspapers this week have reported that the state government is intending to take control of the services 104 and 108 following alleged lapses in their functioning. The reports have said the two services will be merged into one entity. However, some of the reports got the facts wrong. For instance, it was wrongly stated that the government has been paying Rs 10 crore per month to HMRI towards bills run up by 104.
This is an attempt to clarify the position. The Health Management and Research Institute (HMRI) is a not-for-profit organization. It entered into an MoU with the government of AP to deliver healthcare through 104. In this endeavour, the organization received government funds only for operational expenses while management costs were always borne by its founders and patrons. All audited accounts and books of HMRI are examined every year by statutory auditors appointed by the government. No adverse comments or remarks have ever been made against HMRI by any agency.
The government's expenditure on account of HMRI operations have never ever exceeded Rs 8.5 crore per month, even when the 104 health information helpline, the community paramedic training (CPM) programme, health management information systems (HMIS), the integrated disease surveillance programme (IDSP) and the fixed-day health service (FDHS) were in operation together. Ever since the government withdrew FDHS from HMRI without even proper notice on Dec 4, 2010, citing a strike by employees, operational expenditure for the 104 call centre never exceeded Rs 2.07 crore per month.
The government has now decided to cancel the “contract” (though it was an MoU) with HMRI for running 104 with effect from Oct. 1. HMRI has accepted the proposal and is in the process of enabling a smooth takeover by the government.
As far as the capital cost is concerned, all the items that come under capital expenditure were by and large directly procured by the government or by a procurement committee constituted by it. The assets thus procured remain in the name of the government whereas the cost of the software which runs into crores of rupees was borne by the HMRI management.
The Health Management and Research Institute and the Commissioner Health and Family Welfare of the government of AP entered into an MOU to operationalise two important healthcare delivery services for the benefit of vulnerable sections under Public Not-for-Profit Private Partnership (PNPP): namely the 104 Health Information helpline) and the FDHS. The partnership started with 104 to begin with and was extended later to FDHS.
The operational expenditure of these two services was to be borne by the government, whereas HMRI would provide the knowhow and software besides developing various protocols and management. Consequent to the resignation of the founder chairman of HMRI in January 2009, the Piramal Group came forward to support HMRI and Ajay G. Piramal has been the chairman since August 2010.
Since June 2010 sanctions and releases to HMRI by the government, which were to be quarterly advances as per the MOU, were gradually diluted. Quarterly advances were replaced by monthly. Since July 2010, payment delays commenced and monthly advances were almost never adhered to. This resulted in late payments of not only salaries but also other operational expenses. Often, HMRI with its limited resources had to step in avoid any breakdown in the healthcare delivery.
While this was so, there were indications from various quarters that the FDHS programme was planned to be revamped and brought under the Cluster Health and Nutrition Centres. This caused considerable uncertainty and insecurity among the field staff. The 104 Contract Employees Union, affiliated to CITU, went on strike from Nov. 10 2010. Meeting the demands of the employees was not in the purview of HMRI since all of them involved policy matters and financial support from the government. Ultimately, 475 mobile health units which provided once-a-month fixed-day health service at every rural habitation located 3 km beyond a primary health centre were handed over to the district collectors.
The FDHS programme had provided 2.73 lakh van days, visited 22,500 villages on an average of 12 times and screened 116 lakh people. More than 3.5 lakh diabetes cases and seven lakh hypertension cases were diagnosed and referred to doctors. Nearly 13 lakh pregnant women were registered and on an average they were visited three visits. In addition, 20 lakh children below 5, and 20 lakh school children were provided healthcase services.
Since then, HMRI has been attending to only the helpline. Since its inception it has received more than 540 lakh calls benefiting about 200 lakh vulnerable beneficiaries. On an average the helpline receives 30-40 thousand calls daily.
Non-profit organizations try to reach the poor and the disadvantaged, but their sustenance depends on timely funding support from the government. Hence, the survival of the PNPP model is in question. The government has every right to continue or discontinue HMRI services. It is certainly not right to blame a service that did its work till the last minute.
Jwala Narasimha Rao is a consultant for HMRI