1.
Introduction
1.1. In most developing
countries, provision of basic preventive, promotive and curative services is a
major concern of the Government and decision makers. With growing population and
advancement in the medical technology and increasing expectation of the people
especially for quality curative care, it has now become imperative to provide
quality health care services through the established institutions. In public
Sector 15,393 allopathic hospitals (Health Information of India 2003) are
functioning. In the rural areas, the secondary level care is being provided
through 3222 CHCs (Bulletin on Rural Health Statistics in India 2005) with 30
beds each with specialist services of physicians, paediatricians, O & G
specialists, and surgeons being made available. However, these services have not
been successful in gaining the faith and confidence of the people because of
lack of specialists, facilities and accountability, alongwith the paucity of
resources and non-involvement of the community.
1.2. Upgradation of
CHCs to Indian Public Health Standards (IPHS) is a major strategic intervention
under the National Rural Health Mission (NRHM). The purpose is to provide
sustainable quality care with accountability and people’s participation
alongwith total transparency. However, there is a general apprehension that this
may not be possible unless a system is evolved for ensuring a degree of
permanency and sustainability. This requires the development of a proper
management structure which may be called as Rogi Kalyan Samiti (RKS) (Patient
Welfare Committee) / Hospital Management Society (HMS). We have some experience
of these Rogi Kalyan Samities functioning in some of the States like Madhya
Pradesh with good results and feasibility of replication. The project in Madhya
Pradesh was started on a pilot basis and it has now been adopted in over 450
institutions across the State and has proved equally successful in extremely
backward tribal and rural areas, which proves its replicability cutting across
the regions. To take the concept across sections of the community, local
representatives and political regime, the project concept has to be simple,
appealing and easy to replicate across the State.
2.
Concept
2.1. Rogi Kalyan
Samiti (Patient Welfare Committee) / Hospital Management Society is a simple yet
effective management structure. This committee, which would be a registered
society, acts as a group of trustees for the hospitals to manage the affairs of
the hospital. It consists of members from local Panchayati Raj Institutions
(PRIs), NGOs, local elected representatives and officials from Government sector
who are responsible for proper functioning and management of the hospital /
Community Health Centre / FRUs. RKS / HMS is free to prescribe, generate and use
the funds with it as per its best judgement for smooth functioning and
maintaining the quality of services.
3. Basic
Structure
3.1. The suggested
composition of RKS / HMS is as follows:
RKS / HMS would be a
registered society set up in all District Hospitals / Sub District Hospitals /
CHCs / FRUs. It may consist of the following members:-
§
People’s representatives –
MLA / MP
§
Health officials (including
an Ayush doctor)
§
Local district officials
§
Leading members of the
community
§
Local CHC/ FRU
in-charge
§
Representatives of the
Indian Medical Association
§
Members of the local bodies
and Panchayati Raj representative
§
Leading
donors
3.2. The RKS/HMS will
not function as a Government agency, but as an NGO as far as functioning is
concerned. It may utilize all Government assets and services to impose user
charges and shall be free to determine the quantum of charges on the basis of
local circumstances. It may also raise funds additionally through donations,
loans from financial institutions, grants from government as well as other donor
agencies. Moreover, funds received by the RKS / HMS will not be deposited in the
State exchequer but will be available to be spent by the Executive Committee
constituted by the RKS/HMS. Private organizations offering high tech services
like pathology, MRI, CAT SCAN, Sonography etc. could be permitted to set up
their units within the hospital premises in return for providing their services
at a rate fixed by the RKS/ HMS.
4. Need for
Devolution of Responsibility
4.1. Participation of local staff
along with representatives of local population is considered of prime importance
to improve accountability and keep pace with rapidly growing service
requirements. It is also necessary
to evolve a suitable framework within which the existing staff and local
population along with administration can establish such a motivated performing
asset. The new body or the apex entity has to be responsible for the singular
aspect of provision of services to all classes of the society. The right of
independence for performance and management has to be provided in order to boost
performance.
5. Framework
For Rogi Kalyan Samiti (RKS)/Hospital Management
Society(HMS)
5.1 Objectives
the RKS / HMS
The following could be the broad objectives of the
HMS
Ø Ensure compliance to minimal
standard for facility and hospital care and protocols of treatment as issued by
the Government.
Ø Ensure accountability of the
public health providers to the community;
Ø Introduce transparency with
regard to management of funds;
Ø Upgrade and modernize the
health services provided by the hospital and any associated outreach
services;
Ø Supervise the implementation
of National Health Programmes at the hospital and other health institutions that
may be placed under its administrative jurisdiction;
Ø Organize outreach services /
health camps at facilities under the jurisdiction of the
hospital;
Ø Display a Citizens’ Charter
in the Health facility and ensure its compliance through operationalisation of a
Grievance Redressal Mechanism;
Ø Generate resources locally
through donations, user fees and other means;
Ø Establish affiliations with
private institutions to upgrade services;
Ø Undertake construction and
expansion in the hospital building;
Ø Ensure optimal use of
hospital land as per govt. guidelines;
Ø Improve participation of the
Society in the running of the hospital;
Ø Ensure scientific disposal
of hospital waste;
Ø Ensure proper training for
doctors and staff;
Ø Ensure subsidized food,
medicines and drinking water and cleanliness to the patients and their
attendants;
Ø Ensure proper use, timely
maintenance and repair of hospital building equipment and
machinery;
5.2. Functions and
Activities
To achieve the above
objectives, the Society shall direct its resources for undertaking the following
activities / initiatives
Ø Identifying the problems
faced by the patients in CHC/PHC;
Ø Acquiring equipment,
furniture, ambulance (through purchase, donation, rental or any other means,
including loans from banks) for the hospital;
Ø Expanding the hospital
building, in consultation with and subject to any Guidelines that may be laid
down by the State Government;
Ø Making arrangements for the
maintenance of hospital building (including residential buildings), vehicles and
equipment available with the hospital;
Ø Improving boarding / lodging
arrangements for the patients and their attendants;
Ø Entering into partnership
arrangement with the private sector (including individuals) for the improvement
of support services such as cleaning services, laundry services, diagnostic
facilities and ambulatory services etc.;
Ø Developing / leasing out
vacant land in the premises of the hospital for commercial purposes with a view
to improve financial position of the Society;
Ø Encouraging community
participation in the maintenance and upkeep of the
hospital;
Ø Promoting measures for
resource conservation through adoption of wards by institutions or individuals;
and,
Ø Adopting sustainable and
environmental friendly measures for the day-to-day management of the hospital,
e.g. scientific hospital waste disposal system, solar lighting systems, solar
refrigeration systems, water harvesting and water recharging systems
etc.
5.3. Constitution of the RKS /
HMS
Governing
Body:
Chairperson
:
District Magistrate
Member-Secretary
:
Medical Superintendent of the hospital
Members:
§
Chief Executive Officer,
Municipal Corporation
§
Chief Medical and Health
Officer
§
Director, AYUSH of the
District
§
Up to 2 representatives of
PRIs
§
Up to 3 eminent citizens
nominated by the District Collector
§
MNGO
representative
§
Representative of local
Medical College
§
Representative of corporate
sector / NGO hospitals in the city as may be nominated by District
Collector
§
Local
MP/MLA
§
Associate members : An
individual who makes a one time donation of.a specified amount [e.g. Rs 5,000/-
or as may be determined by the District Health Society], may be made eligible to
become a Member of the Governing Body of the Society.
§
Institutional members: Any
institution, which donates a specified amount [e.g. Rs. 50,000/- or more or as
may be determined by the District Health Society] or adopts a ward of the
hospital and bears the cost of its maintenance, may be made eligible to nominate
a person from the institution as a member of the Governing Body of the
society.
5.4 Proceedings of the
Governing body
5.4.1 The meetings of the Governing Body
shall be held at least once in every quarter and at such time and place as the
Chairperson shall decide. If
the Chair-person receives a requisition for calling a meeting signed by
one-third members of the Governing Body, the Chair-person shall call such a
meeting as soon as may be reasonably possible and at such place as s/he may deem
fit.
5.4.2 Following minimum business shall be
brought forward and disposed off in every meeting of the Governing
Body:
·
Compliance to Standards and
Protocols issued by Government.
·
Review of the OPD and IPD
service performance of the hospital in the last quarter and service delivery
targets for the next quarter.
·
Review of the outreach work
performed during the last quarter and outreach work schedule for the next
quarter.
·
Review of efforts in
mobilizing resources from the community, trade / industry and local branches of professional
associations like IMA and FOGSI etc.
·
Review the reports submitted
by the Monitoring Committee.
·
Review the status of
utilization of funds, equipment and drugs received under different programmes of
the Government.
·
Review compliance to
Citizens’ Charter displayed in the Hospital and the effectiveness of the
Grievances Redressal Mechanism.
5.4.3 In addition to the above regular
items, the Annual Report of the Society relating to last financial year shall
also be taken up for discussion in the quarterly meeting falling due after the
close of every financial year.
5.4.4 Every notice calling meeting of the
Governing Body shall state the date, time and place at which such meeting will
be held and shall be served upon every member of the Governing Body not less
than twenty one clear days before the date appointed for the meeting. Such notice shall be issued by the
Member Secretary of the Society and shall be accompanied by an agenda of the
business to be placed before the meeting provided that accidental omission to
give such notice to any member shall not invalidate any resolution passed at
such meeting. In the event of any
urgent business the Chair-person may call the meeting of the Governing Body at
clear ten days notice.
5.4.5 The Chairperson shall Chair the
meetings of the Governing Body. In his/her absence, the Governing Body shall elect one from
among the members present as Chair-person of the meeting.
5.4.6 One third of the members of the
Governing Body, including the substitutes nominated under Rule 5.3.8 present in
person, shall form a quorum at every meeting of the Governing
Body.
5.4.7 The membership of an ex-officio
member of the Society and of the Governing Body shall stand terminated when
he/she ceases to hold the office by virtue of which he/she was member and
his/her successor to the office shall become such member.
5.4.8 Nominated members shall hold office
for a period of three years from the date of their nomination. Such members will
be eligible for re-nomination for another period of 3
years.
5.4.9 The Society shall maintain a roll of
members at its registered office and every member shall sign the roll and state
therein his/her rank or occupation and address. No member shall be entitled to exercise
rights and privileges of a member unless he/she has signed the roll as
aforesaid.
5.4.10
A member of the Society shall cease to be members
if s/he resigns, becomes of unsound mind, becomes insolvent or is convicted of a
criminal offence involving moral turpitude or removal from the post by virtue of
which s/he was holding the membership.
5.4.11 Resignation of membership shall be tendered to the Governing Body in person to its Member Secretary and shall not take effect until it has been accepted on behalf of the Governing Body by the Chairperson.
5.4.12
If a member of the Society changes his/her address he/she shall notify
his/her new address to the Member Secretary who shall thereupon enter his/her
new address in the roll of member.
But if a member fails to notify his/her new address the address in the
roll of members shall be deemed to be his/her address.
5.4.13
Any vacancy in the Society or in the Governing Body shall be filled by
the authority entitled to make such appointment. No act or proceedings of the Society or
of the Governing Body shall be invalid merely by reason of the existence of any
vacancy therein or of any defect in appointment of any of its
members.
5.4.14 No member of the Society or its
Governing Body shall be entitled to any remuneration.
5.5. Powers of the
Governing Body
5.5.1 The Governing Body will have full
control of the affairs of the Society and will have authority to the exercise
and perform all the powers, acts and deeds of the Society consistent with the
aims and objects of the Society.
5.5.2
In particular and without
prejudice to the generality of foregoing provision, the Governing Body
may:
·
Make, amend, or repeal any
bye laws relating to administration and management of the affairs of the Society
subject to the observance of the provisions contained in the Act, provided
that:
o
proposals for amendments shall be placed before the
Governing Body of the District Health Mission for its consideration and
endorsement;
o
proposals for amendment
shall also be sent to the designated authority of the State Government for
endorsement; and
o
proposals shall be brought
to the Governing Body after completing
the above endorsement / approval process.
·
Consider the annual budget
and the annual action plan, its subsequent alternations placed before it and to
pass it with such modifications as the Governing Body may think
fit.
·
Monitor the financial
position of the Society in order to ensure smooth income flow and to review
annual audited accounts.
·
Accept donations and
endowments or give grants upon such terms as it thinks
fit.
·
Delegate its powers, other
than those of making rules, to the Chair-person, Vice-Chair-person or other
authorities as it may deem fit.
·
Authorize the Member
Secretary to execute such contracts on behalf of the Society as it may deem fit
in the conduct of the business of the Society.
·
Recruit medical and
paramedical staff for the hospital and execute such other contracts for the
improvement of hospital services as it may deem fit.
·
Do generally all such other
acts and things as may be necessary or incidental to carrying out the objectives
of the Society or any of them, provided that nothing herein contained shall
authorize the Governing Body to do any act or to pass any bye-laws which may be
repugnant to the provisions hereof, to the powers hereby conferred on the
Governing Body and other authorities, or which may be inconsistent with the
objectives of the Society.
·
Ensure compliance to Indian
Public Health Standards and to Citizens’ Charter.
·
Establish a system of public
grievance redressal at facility level.
·
Undertake measures to
increase transparency in financial and operational management of the
hospital.
5.6 Powers and functions of
the Chairperson of the Governing Body
5.6.1 The Chairperson shall have the
powers to call for and preside over all meetings of the Governing
Body.
5.6.2 The Chairperson may himself/herself
call, or by a requisition in writing signed by him/her, may require the Member
Secretary to call, a meeting of the Governing Body at any time and on the
receipt of such requisition, the Member Secretary shall forthwith call such a
meeting.
5.6.3 The Chairperson shall enjoy such
powers as may be delegated to him by the Society and the Governing Body.
5.6.4 The Chairperson shall have the
authority to review periodically the work and progress of the Society and to
order inquiries into the affairs of the Society and to pass orders on the
recommendations of the reviewing or inquiry Committee.
5.6.5 Nothing in these Rules shall
prevent the Chairperson from exercising any or all the powers of the Governing
Body in case of emergencies in furtherance of the objects of the Society.
However, the action taken by the Chairperson on such occasions shall be reported
to the Governing Body subsequently for ratification.
5.6.6 All disputed questions at the
meeting of the Governing Body shall be determined by votes. Each member of the
Governing Body shall have one vote and in case of a tie, the Chairperson shall
have a casting vote.
5.6.7 Should any official members be
prevented for any reason whatsoever from attending a meeting of the Governing
Body, the Chairperson of the
Society shall be at liberty to nominate a substitute to take his place at the
meeting of the Governing Body. Such
substitute shall have all the rights and privileges of a member of the Governing
Body for that meeting only.
5.6.8 Any member desirous of moving any
resolution at a meeting of the Governing Body shall give notice there of in
writing to the Member Secretary of not less than ten clear days before the day
of such meetings
5.6.9 Any business which it may become
necessary for the Governing Body to perform, except the agenda prescribed for
the full meeting as set out as above
may be carried out by circulation among all its members and any
resolution so circulated and approved by majority of the members signing shall
be as effectual and binding as if such resolution had been passed at a meeting
of the Governing Body provided that at least one third members of the Governing
Body have recorded their consent of such resolution.
5.6.10 In the event of any urgent business, the
Chairperson of the Society may take a decision on behalf of the Governing
Body. Such a decision shall be
reported to the Governing Body at its next meeting for
ratification.
5.6.11
A copy of the minutes of the proceedings of each meeting shall be
furnished to the Governing Body members as soon a possible after completion of
the meeting.
5.7 Executive
Body
Chair-person
:
Medical Superintendent of the hospital
Member-Secretary
:
Senior Medical Officer of the District Hospital, nominated by
Superintendent of the hospital
Members:
§
PRI representative to the
Governing Body
§
District Collector's
nominees to the Governing Body
§
Representatives of
institutional members, if any
§
Additional members as may be
co-opted by the executive Body
5.7.1. Meetings of the Executive Committee shall
be convened by the Member Secretary by giving clear seven days notice in writing
along with the Agenda specifying the business to be transacted, the date, time
and venue of the meeting.
Frequency of
meetings: Once every month
5.8 Regular Agenda
§
Review of the OPD and IPD
service performance of the hospital in the last month and service delivery
targets for the next month.
§
Review of the outreach work
performed during the last month and outreach work scheduled for the next
month.
§
Consider reports of the
Monitoring Committee for remedial action
§
Implementation of the
Citizens’ Charter
The minutes of the Executive Committee meetings will be placed before the
Governing Body at its next meeting.
5.9
Monitoring
Committee
A Monitoring Committee could be constituted by the Governing Body to
visit hospital wards and collect patient feedback. The Committee would send a monthly
monitoring report to the District Collector and Chairperson, Zilla
Parishad.
5.10 Bodies of the Society for
sub-district level hospitals
5.10.1 Governing Body
Chairperson
:
Sub Divisional Magistrate / Block Development Officer, Panchayat Samiti
Co-chair
: District programme officer
(deputy CMO or equivalent)
in charge
Member-Secretary : A Senior Medical Officer of
the Hospital, nominated by
Officer-incharge of the hospital Superintendent of
the
hospital
Members:
§
Officer-in-charge of the
hospital
§
An AYUSH doctor from a
CHC
§
Block level officers of
ICDS, rural development, Panchayati Raj, Water and sanitation, education and
social welfare
§
Representative of health
sector NGO working in the area
§
An eminent citizen from the
town / city, nominated by the District Collector
§
An eminent citizen from the
town / city, nominated by the Chairperson, Panchayat Samiti, Chief Executive
Officer, Nagar Nigam (if applicable)
§
Associate
members/Institutional members: Same as for District Hospital
Society
§
PRI
representative
Frequency of meetings and
regular agenda: Same as for district hospital society
Chairperson
:
Officer in charge of the hospital
Member secretary
:
Member Secretary of the Governing Body (Medical
Officer of the Hospital, nominated by
officer in charge
Superintendent of the
Hospital
Members:
§
Two PRI representatives to
the Governing Body
§
District Collector / SDM's
nominee to the Governing Body
§
Block level officers of
ICDS, Water and sanitation and education
§
Representatives of
institutional members, if any
Frequency of meetings and
regular agenda: Same as for district hospital society
5.10.3 Monitoring Committee
Could be on the same pattern as in District
Hospital.
5.11 Provision of enabling
rights, vesting assets & authorizing services
The Govt. may authorize
transfer of existing facilities and assets free of cost and without any
liability to the RKS / HMS of the concerned hospital. In most hospitals, the
principle reasons for malfunctioning and deteriorating services are the
inability to spend on new infrastructure for upgradation & modernization,
paucity of funds for emergencies, gross mismanagement of resources and lack of
motivation. Being a service oriented facility, it needs to permit and grant
specific rights to allow freedom for operations and management. The RKS / HMS
should be enabled with the decision making right to invest in order to meet
service requirements. As mentioned above, user charges should be introduced, as
it is believed that excellent health care on a continuous basis cannot be
ensured without adequate financial provisions. Appropriate relaxations for BPL
patients to be ensured, as per State policy.
5.12 Resource
Mobilization
The funds of
the Society shall consist of the following:
·
Grant-in-aid from the State
Government and/or State level society (societies) in the health sector and/or
District Health Society.
·
Grants and donations from
trade, industry and individuals.
·
Receipts from such user fees
as may be introduced for the services rendered by the hospital.
·
Receipts from disposal of
assets.
5.13 Accounts
and Audit
·
The Society shall cause
regular accounts to be kept of all its monies and properties in respect of the
affairs of the Society.
·
The accounts of the Society
shall be audited annually by a Chartered Accountant firm included in the panel
of Chartered Accountants drawn by the designated authority of the State
Government.
·
The report of such audit
shall be communicated by the auditor to the Society, which shall submit a copy
of the Audit Report along with its observation to the District Collector.
·
Any expenditure incurred in
connection with such audit shall be payable by the Society to the
Auditors.
·
The Chartered Accountant or
any qualified person appointed by the Govt. of India/State Government in
connection with the audit of the accounts of the Society shall have the same
rights, privileges and authority in connection with such audit as the Auditor
General of the State has in connection with the audit of Government accounts and
in particular shall have the right to demand the production of books, accounts,
connected vouchers and other necessary documents and
papers.
5.14 Bank
Account
The account of the Society
shall be opened in a bank approved by the Governing Body. All funds shall be paid into the
Society’s account with the appointed bank and shall not be withdrawn except by a
cheque, bill note or other negotiable instruments signed by the Member-Secretary
of the Society and such one more person from amongst the Executive Committee
members as may be decided by the Governing Body.
5.15 Annual
Report
A draft Annual Report and
the yearly accounts of the Society shall be placed before the Governing Body at
its ensuing meeting that may be held in the first quarter of every financial
year.
A copy of the annual report
and audited statement of accounts as finally approved by the Governing Body
shall be forwarded within six months of the closure of a financial year to the
following:
·
District Collector.
·
Chair-person, Governing
Body.
·
Chair-person, Executive
Body.
·
Chair-person, Zilla
Parishad.
·
Chair-person, Urban Local
Body [ Nagar Nigam].
5.16 Suits and proceedings
·
The Society may sue or be
sued in the name of Society through its Member Secretary.
·
No suit or proceedings shall
abate by the reason of any vacancy or change in the holder of the office of the
Chair-person or Member Secretary or any office bearer authorized in this behalf.
·
Every decree or order
against the Society in any suit or proceedings shall be executable against the
property of the Society and not against the person or the property of the
Chair-person, Member Secretary or any office bearer of the Society.
·
Nothing in sub-rule as above
shall exempt the Chair-person, Member Secretary or office bearer of the Society
from any criminal liability or entitle him/her to claim any contribution from
the property of the Society in respect of any fine to be paid by him/her on
conviction by a criminal court.
5.17
Amendments
The Society may alter or extend the purpose for which it is established and/or the Rules of the Society, provided that such amendment shall only be carried out through the procedure set out in rule as above.
5.18
Dissolution
·
The Governing Body may
resolve to dissolve the Society by bringing a proposal to that effect in a
special meeting to be convened for the purpose, provided that the proposal for
dissolution has been duly approved /endorsed through the process prescribed for
amendment as set out in rule as above.
·
The dissolution proceedings
shall be made in accordance with the provisions of the Act as amended from time
to time in its application in the State.
·
Upon the dissolution of the
Society, all assets of the Society, after the settlement of all its debts and
liabilities, shall stand reverted to the State Government for such purposes as
it may deem fit.
5.19 Contracts
·
All contracts and other
instruments for and on behalf of the Society shall be subject to the provisions
of the Act, be expressed to be made in the name of the Society and shall be
executed by the persons authorized by the Governing Body.
·
No contracts for the sale,
purchase or supply of any goods and material shall be made for and on behalf of
the Society with any member of the Society or his/her relative or firm in which
such member or his/her relative is a partner or shareholder or any other partner
or shareholder of a firm or a private company in which the said member is a
partner or director.
5.20 Common seal
The Society shall have a
common seal of such make and design as the Governing Body may approve.
5.21
Government power to
review
The
District Health Society shall review, monitor and evaluate the performance of
the Rogi Kalyan Samities at the District/Sub District levels.