Monday, October 22, 2012

ECHS : A Few Samples Of Quality Of Medical Care Delivery

If an objective, unbiased view is to be formed of the efficacy of ECHS as a system, one ought to, first of all, obtain an awareness of the limitations under which the medical and administrative staff function and the extra mile some of them cover to compensate for lacunae and shortcomings in respect of resources. 

With an appreciation, of the efforts made by the doctors and managers, as the first stepping stone towards reaching an understanding of what more needs to be done, perhaps the next step ought to be a random sampling of some of the common experiences of the user-stakeholders . 

The quality of experience is never constant. It can vary from time to time and from one polyclinic to another. As an example, at some polyclinics a couple of issues have been a source of difficulty lately: 

Procedures For Collecting Medicine: A few medicines are sometimes unavailable at any typical ECHS polyclinic. In order to collect such medicines, veterans share the following experiences: 

v An ECHS member waits in queue to register for consultation. 

v Then, he or she waits in queue for the turn to consult with the specialist. 

v After the consultation, there is another wait in another queue for having the medicine dispensed at the collection counter. The ECHS member gets the prescription back with the unavailable medicines circled in red with the annotation "N/A". 

v This piece of paper has to be taken to another counter for getting rubber stamps affixed. 

v The rubber-stamped prescription has to be taken back to the doctor for his signature. 

v The patient then proceeds to the Officer In-charge of the polyclinic for his counter-signature. 

v Then, with this document, the ECHS member proceeds to the nearest Military Hospital/Base Hospital/Command Hospital, most likely to be situated miles away, which dispenses drugs, not available at polyclinics. 

v Then, the patient again waits in a queue at the MH/BH/CH medicine-counter for ECHS. Sometimes, some of the medicines are also not available at the MH/BH/CH, in which case the personnel at the dispensing counter endorse the non-availability in the record book of the patient. 

v The patient then repeats the whole or part of the process outlined above, several days later. 

Procedure For Issue Of "All India" ECHS Cards: Of late, ECHS cards are being issued on an "All India" basis. With these, an entitled veteran can avail ECHS facilities at polyclinics other than the parent polyclinic in case the entitled veteran happens to be out-of-station and requires medical help. 

v This ought to count as an improvement with the only rider being that this could have been incorporated at the very outset, especially considering that the complete data of the entitled veteran is captured in digital format anyway. The need to apply afresh for a card can be reviewed and the feasibility of converting the existing cards, to the pan-India mode, can be examined. 

v But keeping in view the fact that smart card vendors also contribute to the national GDP and that one ought not to begrudge them a modest fee for issue of the pan-India cards, it ought to be possible, with a little mental effort, to put that issue aside. What appears more in need of rationalisation is the process adopted for issue of these pan-India cards.
a.   Firstly, the application forms are available only at the regional ECHS centres situated miles away in a cantonment. Even a quick glance at the forms reveals these are not security-press creations. It's easy enough to realize even a handwritten application based on a common facsimile would suffice just as nicely.
b.   The applications can be submitted at the polyclinic and dispatched in batches to the regional centre. There is no reason why the entire process can’t be done online. In any case, there may well be some room for reviewing the current requirement of making one trip for collecting the form, another for getting a demand-draft made at a bank and yet another trip back to the regional centre for submitting the completed application. 

c.   After the application has been submitted, the staff on duty at the ECHS Regional Centre convey the information that the cards would be delivered after about three months. One needs to consider that even civilian departments, not famous for being especially citizen-friendly, deliver such cards within a week or a fortnight. So, perhaps, there also exists a need to rationalise the process time of 3 months for issue of a smart card in this day and age. 

d.   Even payment of Municipal Taxes in the present networked age has been simplified and made possible online for the general civilian public. It may not be out of place to consider the archaic nature of the practice of getting drafts made for ECHS cards and replacing it with the facility of making payments through online banking. 

e.   Bureaucratic processes of the civilian variety are not exactly suited to military organisations and the military style of management. When civilian red-tape is not exactly everyone's cup of tea amongst the defence brotherhood, surely convenient processes that involve a simple click or two of the mouse would be the logical choice for ensuring the delivery of a service to veterans of the Indian armed forces. 

Now, for all one knows, these experiences may not be all that common across the country. In some parts, difficulties of another kind might be the norm. Comments are invited for enlightening all stakeholders in the system and for providing constructive feedback to effect changes wherever possible.