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.

 

Dissecting The V CPC Pay Fixation Formula

{Edit: 16Apr2017: It is gratifying to know this blog-post continues to draw views and interest almost five years after it was published. There may well be as yet unresolved issues regarding the Rank Pay matter. However for the Officer cadre, as well as veteran Officers, there is that other totally unresolved issue of the selection of date of implementation of phase-I recommendations of AV Singh Committee. Just like the rank pay matter, that issue affects all Officers who were serving and also those who had retired by the time the recommendations were implemented. For some time now, I have permanently linked that issue to the right of the blog page as a "Featured Post". All pre 2004 commissioned Officers still in service and veterans could consider going through the matter that affects them all. Here is another link that can be clicked on to view all connected posts}

With the recent distraction caused by news on the COS Report regarding pension anomalies, the spotlight has shifted somewhat from the crunch issue of arriving at a reasonable understanding of implications of the "Rank Pay" case judgement.
It's heartening to note that even the agencies responsible for implementing the judgement have begun to issue some notices on the matter on their web-sites. Some of the lingering doubts regarding the applicability of the judgement post V and VI CPCs are being gradually dispelled as the afore-mentioned notices mention calculations post V and VI CPCs.

Making a reasonable assumption on the manner of the initial fixation of basic at IV CPC, it should be possible to arrive at a, again, reasonable estimate of what the basic pension pay would have been as on 31 Dec 95. Here the result of the efforts of the countless spread-sheet warriors, who had descended on the scene, could prove useful.

The real issues here too would be:

*The viability of the formula used by V CPC for working out the emoluments.

*The manner of addition of Rank Pay to the emoluments.

*The fixation of the worked out revised basic in the appropriate pay-scale corresponding to each rank.
To recall, V CPC had used the following formula for adding up the unrevised emoluments relating to Jan 96: 

1.4[{Un-Revised Basic+Stagnation Pay}+Un_Revised Rank Pay]+DA+IR-New Rank Pay 
The following points cloud the issue somewhat:
    *It's not clear why the IV CPC Rank Pay was added to the sum and not the revised, and higher V CPC Rank Pay.
    *Why, after adding the lower amount of the unrevised rank pay, the higher amount of the revised rank pay was subtracted from the aforementioned calculated amount for fixing the new revised basic in the appropriate pay-scale.
If the logic of adding rank pay for calculating to the emoluments, as understood from the judgement, is to be followed, the formula ought to have been as follows:


1.4[{Un_Revised Basic+Stagnation Pay}+Revised Rank Pay]+DA+IR
A third alternative could have been to add the unrevised rank pay but not subtract the new revised rank pay, as follows:

     1.4[{Un_Revised Basic+Stagnation Pay}+Un_Revised Rank Pay]+DA+IR 

{Edit}: A fourth alternative would be to retain the old rank-pay in the 40% component but to add the new rank pay for fixation. Let's not forget, at IV CPC the rank-pay which was then "new" was to be added (but wasn't) to the emoluments. At that time the "old" rank-pay was nil and did not figure in the calculation in the 20% component of the IV CPC formula. So we get the fourth alternative as follows:

1.4{Un_Revised Basic+Stagnation Pay}+0.4{Un_Revised Rank Pay}+DA+IR+Revised Rank Pay


Now giving specific examples, or making actual calculations, would be foolhardy in the extreme. We need to get some sort of an indication which one of these alternatives would be most rational in light of the actual arguments that took place during the litigation.

Only through a process of exchange of views and ideas can one hope to arrive at a rational solution to the V CPC stage of the puzzle.
A trial calculation yields the following alternatives for the minimum basic pay of each rank:

Rank
Unrevised
 Starting
Basic
Pay For
Rank In
IV CPC
 Scale
IV CPC
Rank Pay
DA
IR I
IR II
V CPC
Rank
Pay
V CPC
Formula
Alt 1
Alt
Formula
2
Alt
Formula
3
Alt
Formula
4
Starting
Pay In
Rev
Pay Scale
Next
Applicable
Increment
I
II
III
IV
V
VI
VII
VIII
IX
X
XI
XII
XIII
1.4(II+ III)
+
IV+
V+
VI-VII
1.4(II+ VII)
+
IV+
V+VI
1.4(II+ III)
+
IV+V+
VI
1.4(II)+
0.4( III)
+
IV+V+
VI +VII
Capt
2900
200
4588
100
310
400
8938
9618
9338
9538
9600
300
Maj
3400
600
5180
100
400
1200
10080
12120
11280
11880
11600
325
Lt Col
3900
800
5217
100
470
1600
10767
13487
12367
13167
13500
400
Col
4500
1000
6105
100
550
2000
12455
15855
14455
15455
15100
450
Brig
4950
1200
6660
100
615
2400
13585
17665
15985
17185
16700
450






IV CPC Pay Fixation: The "Additional-Increments Vs Scale-Change" Debate

In the absence of any direct guidelines, hints from the direct litigants or a communication from the MOD, going through the process of guesswork attached to the implementation of the "Rank Pay" judgement is a bit like gingerly navigating through a pitch dark room with the knowledge of the ever-present risk of bumping into an article of furniture.
 
Some of the inputs on the subject do serve to mislead. Let's take the "Naval Brief" for instance. What practical purpose would be served by adding the rank pay to the sum of Un-revised Basic Pay, DA, IR and 20% of Basic Pay if one is to subsequently subtract the same rank pay from the sum? One might as well not bother about rank pay in that case and settle for the fixation that was done on the sum of 1.2(Basic_Pay), DA and IR and, once again, the fixation would still be as per the years of service and it'd be governed by the Basic Pay defined for each stage in the IV CPC running pay-scale. In effect, arrears would amount to a big fat zero. I don't think that's what the decades long litigation was about.
 
The most important insight that was offered in the matter has been commented upon here. The most useful views that have been received on the subject are of a subtle variety. One has to piece together some concept of what the real situation is from one's inferences.
 
I had attempted to highlight what the running pay-scale would look like if each rank stage was fixed with the sum of rank pay and the emoluments calculated by adding 20% of unrevised BP to DA, IR and unrevised BP. The increments would have to change and the increments would not be logical, as was keenly spotted here. We cannot change the number of stages in between ranks and the revised basic after adding rank pay is fixed for the starting rank of each rank. The net result is a sort of distorted running pay-scale with increments that go up and down without any logic other than of needing to fit in with the other constraints the assumptions place on the manner of fixation.
 
Therefore, we come to the other alternative for fixation, frequently mentioned in forums and blogs, of granting extra increments to each Officer while using the same old running pay-scale.  But it is to be remembered the rank-stages do not change in the running pay-scale. If they did we'd again be presented with the distortions in increments. The increments here are only for fixing the pay of Officers by taking the rank-pay into account.
 
But, in this "model" of fixation an Officer promoted subsequently to the rank of Capt would still get Rs. 2900/- as basic on completing 6 yrs, a Major Rs.3400/- on completing 12 years, and so on. As the pay-scale ends at Rs. 5100/-, this model permits only one increment in the rank of Brig.
 
This kind of pay fixation was covered in a previous blogpost. But to view it in isolation, for the sake of clarity and an emphasis on pay fixation with increments, here is another version.
 
Rank Stage Fixed By IV CPC Running Pay Scale
Basic Pay as Defined In Pay Scale
A Model For Fixation Of Pay Arrived At By Adding Rank Pay To Basic Pay Of Pay Scale {For An Officer With The Min Service For Each Rank Stage As On Date Of Fixation}
 
 
 
2nd Lt
2300
2nd Lt
 
2400
 
Lt
2500
Lt
 
2600
 
 
2700
 
 
2800
 
Capt
2900
 
 
3000
 
 
3100
Capt with 2 increments
 
3200
 
 
3300
 
Maj
3400
 
 
3500
 
 
3600
 
 
3700
 
 
3800
 
Lt Col
3900
 
 
4050
Maj with  6 increments
 
4200
 
 
4350
 
Col
4500
 
 
4650
 
 
4800
Lt Col with 6 increments
Brig
4950
 
 
5100
Brig with 1 increment & Col with 4 increments