Last week I wrote about innovations and reforms introduced by the K-RICH team of the Directorate of Health Services, Kashmir. This column will detail some forthcoming projects which are pending approval and two proposals that have the potential to revolutionise healthcare delivery in Kashmir.
A major innovation by the K-RICH team was the development of a comprehensive plan for Emergency Medical Services (EMS) incorporating a world-class 108 Emergency Ambulance Service and 104 Health Helpline Service under PPP mode. Dr Niyaz Jan was instrumental as his dissertation work was related to EMS services in J&K. The entire process including development of EoI, RFP and tendering process was facilitated by K-RICH.
M/S GVK-EMRI, who are acknowledged leaders in EMS in India were selected as the private partner for the JKATS EMS project. The service is expected to roll out soon across the state of J&K.
The concept of River Ambulances to avoid traffic bottlenecks while transporting patients was also developed by my team as well as a joint-venture with J&K Tourism Department to provide healthcare services in the inaccessible areas of Dal Lake.
Another area high-focus area for the government is development of Public Private Partnerships in healthcare. The K-RICH team identified key areas and developed comprehensive Public Private Partnership (PPP) proposals for setting up Advanced Cardiac Care Centres, Advanced Dialysis and Nephrology Centres, and Cancer Palliative Centres in Kashmir.
K-RICH also developed a model for a pilot project for field testing of innovative equipment like Swasthya Slate developed by Dr Kanav Kahol, Head of the 'Affordable Technology' Division of the Public Health Foundation of India (PHFI) for Indian conditions in the rural districts of Kashmir as a joint venture between the Directorate & PHFI.
A modern Drug Warehouse for scientific storage, management and distribution of medicines to be constructed at Bemina was conceptualized and designed and an outline for a State Drug Corporation was proposed as one component of a comprehensive e-procurement and drug and material management initiative of the Department of Health & Family Welfare.
The K-RICH team also finalized a new Health Secretariat building to house the Directorate of Health Services and other directorates like Family Welfare, SM, and NRHM etc. The concept includes a corporate-based design with all modern public and business amenities including a 500-seat Auditorium.
Planning for the Future
Far reaching as these reforms and innovations may be, more needs to be done. I have proposed two concepts whose potential deserves to be explored.
The first concept which I feel we must adopt is the Zone Management concept. Based on the unique geography of the Kashmir Valley, which is 135 km long but only 32 km wide, it should be divided into three zones for optimal delivery of healthcare and disaster management services:
A. Central Zone – Srinagar, Ganderbal, Bandipora, Budgam and Pulwama Districts with JLNM Hospital Srinagar being designated as the Central Zone Referral Hospital.
B. North Zone – Baramulla and Kupwara Districts with District Hospital Baramulla (DHB) being designated as the North Zone Referral Hospital.
C. South Zone – Anantnag, Kulgam and Shopian Districts with District Hospital Anantnag DHA) being designated as the South Zone Referral Hospital.
Ideally the Zonal Referral Hospital should be part of a Zonal Medical College, but initially the hospital could simply be upgraded with tertiary level staff and facilities. This will ensure that every patient in Kashmir can reach a fully-equipped well-staffed Zonal Referral Hospital within one hour – the ‘golden hour’ in emergency care. If required, the patient can avail a post-stabilisation inter-facility ambulance transport service to a tertiary care hospital. This service has been planned by my team as the ALS component of the JKATS EMS project.
The second concept that I proposed was the setting up of DNB courses in our district hospitals. Diplomate of National Board (DNB) degree is equivalent to M.D Degree.This will ensure that sufficiently motivated doctors are available in the hospitals round-the-clock. This proposal was enthusiastically followed up by Dr Omar Salim Akhtar, who came up with a comprehensive document which has been submitted to the Union Government for approval and funding.
If approved and repeated in other states, this one concept can have a revolutionary effect on healthcare delivery at the international level as India supplies health manpower to many other countries. Just imagine the enormity of the impact if postgraduation facilities become available in all 22 districts of J&K State compared to only the 2 capital districts.
Till DNB training facilities or Zonal Medical Colleges are set-up the problem of trained manpower can be addressed by inter-zonal pooling of specialists.
The ultimate aim is to deal with the patient load at the zonal level itself so that the pressure on central hospitals is relieved to the point that they can truly start functioning as tertiary level research institutes.
The K-RICH team worked with many people who did not belong to Kashmir yet made extraordinary efforts to help alleviate the suffering of our patients. Mr Ulrich Balke, InterPLAST co-ordinator, all former and current staff members of ICRC in Kashmir, and Dr Kanav Kahol of PHFI were eager to collaborate on healthcare projects in Kashmir. Dr Eric Bernes, master trainer of the ICRC deserves special mention for his efforts in imparting BLS trainings in less developed regions of the world especially Kashmir.
The efforts of K-RICH were a part of the overall focus of the Directorate of Health Services to improve healthcare delivery as well as accountability.
In the first year itself (2011-1012), the performance statistics were astonishing with significant increase in all performance parameters – OPD performance increased by 30.5%, IPD by 33.5 %, Investigations by 48.5 % and Major Surgeries by 38.5% over the previous year. Similar improvements were noted in the following year. Advanced surgeries are now routinely being conducted at district level. The scale of these improvements culminated in the State of J&K being awarded as the best performing state in Primary Healthcare in India with the award being personally received by the Hon’ble Chief Minister.
Ideas and suggestions for improving the healthcare delivery system in J&K are welcome.
Postscript: After this article was submitted, news came of the approval granted by Union Ministry of Health for medical colleges to be started in Anantnag and Baramulla Districts. This will give a huge boost to the concept of the Zone-based healthcare delivery system when and if it is put into practice.
Link: Newspaper version in Greater Kashmir