Evaluating PPP Models in handling emergency healthcare services in India

Efficient healthcare services forms an essential pillar of any society that values its well being and productivity. And emergency management is a critical part of it. In a country where a chunk of the population still hasn’t got access to healthcare services, it becomes all the more relevant. And when you think that in India, a lot of deliveries in this age are still conducted at homes, by semi -skilled dais, which often leads to various problems for both the mother and the new-born, the problem becomes acute. It is no wonder hence that the country is having a hard time reducing the maternal mortality rate and the neonatal mortality rate, which are key healthcare indicators of any country.

 

So, when I came to know that the government of Gujarat, in association with GVK had rolled out a service dedicated to providing quality emergency healthcare services, free of cost, to the citizens, I had to visit the facility to find out how the operations were being carried on.

In fact, a lot of us had expressed their desires to find out how this system worked, and so a visit to its integrated call center was arranged by one of our professors. Upon reaching the facility we were quite surprised to find similar architectural designs as our college, which was due to the same architect- Vimal bhai, designing it. The concrete buildings couldn’t be mistaken as they had his typical trademark. Housed within those walls, was a highly efficient system of managing emergency healthcare services.

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Emergency Management and Research Institute or EMRI, as it was called

The basic flow chart was- a person in need of urgent medical assistance calls on 108, the call is routed to this center, where an operator answers it. It was up to the operator to decide whether the person needed urgent transportation to healthcare institutes- he or she can also take the opinion of resident doctors of the facility to aid in their decision-making process. If an ambulance is needed, the nearest one is located through GPS and contact created. Within fifteen minutes of receiving the call, the ambulance usually arrives at the scene, depending on the geographical location. It sounded similar to the model followed by app cabs, but there were subtle differences. Real time traffic data from google, information on doctors and departments in nearby hospitals, etc were all built into the system that helped the team to decide which hospital to direct the patient to, and which route to take. GVK had built up an efficient team of paramedical staff, trained at this institute itself, who were responsible for providing the care at first contact. There were even facilities for live steaming of the data about patients vitals, like Blood pressure, pulse and even ECG readings to the doctors on the facility. They could then guide the personnel on the condition of the patient, and how to assist him.

The choice of the hospital depended on the patient, or else he was rushed to the nearest one available at that hour. Availability of beds, or doctors of a particular specialty may be  the information that if added to the system could make it even more efficient.

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The call center- which formed the core of the institute

 

We were shown around the campus by Dr Jayraj Desai and his associate, who seemed very enthusiastic about the work they were doing, in fact every employee on the spot seemed very passionate about their jobs- and we were sure it would translate to optimum utilization of their capabilities. In high intensity jobs, where you need to be fully alert all the time, that definitely is a big plus. The ambulances, 585 in number, were provided with top of the line infrastructure, that got renewed from time to time. The facility operated on   a Public private partnership (PPP) model, wherein most of the service part was provided by GVK, and the funding was mostly taken care of by the government. This facility had been rolled out in a few other states and union territories too, and needless to say, had been a huge success.

 

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The standard ambulance, which is equipped with top of the line devices for all kinds of emergency management

 

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Special ambulances meant for transferring back mothers and their newborn to their homes
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Dr Jayraj Desai (Head EML&C) and his associate Ashish were very conducive to all our queries, and patiently addressed all our demands

 

Having been a medical inspector, for the past few years, I had carried out inspections at various facilities, and had to often suggest recommendations for keeping them in line with the latest trends, and to ensure optimum utilization of resources. It wasn’t easy to please me, my colleagues told me. However, this was one facility I was very impressed by- these guys were doing an excellent job of integrating information technology, for providing seamless services to the patients- which was the need of the hour. In a country like India, IT integration with healthcare was one of the best ways to increase healthcare service penetration to the masses, and ensure that no one was deprived of the basic medical facilities. It helped to cut through the barriers that prevented people from accessing such services.

There were a few areas for improvement, however, that can be implemented (my cynical traits come in). I made a few suggestions, which were duly noted.

However, the basic structure of operations was streamlined to cut off the extra flak, and was a lesson in how to handle operations on such a large scale. The fact that the personnel manning the ambulances were trained by the institute itself, ensured that the liability of providing top notch services lay with them, which ensured greater dedication and willingness to keep affront of newest technological advances. A small mistake could prove to be fatal here, and they couldn’t afford to make one.

Over the years of my work life, I have realized the main problem in our country In healthcare stems from two factors- lack of adequate healthcare personnel and lack of adequate infrastructure. However, in urban and semi urban areas, the second factor wasn’t really an issue, so what we needed now was to address the lack of personnel. These guys were doing a great job out of it by creating their own staff, training them and subjecting them to frequent assessments. They did not need to hire from outside- which would have created a bottleneck, and would also have planted doubts about the quality of staff being hired.

 

EMRI (Emergency management Research Institute- the name of the facility), has also come up with some additional services like providing assistance to women, who call on their no for help 24*7, along with ambulance facilities for transferring back the mother and her new born child to their homes. Counselling facilities are also available for cases of domestic violence, as and when reported. As these guys were doing a great job, the government was perhaps trying to outsource more and more services to them!

We came back, after spending three hours at the institute- our minds full of appreciation for the task being performed here. Some of the more entrepreneurship oriented among us had also started forming plans of their own.

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Having a feel of the classes taken here


Archya, is a doctor-turned-healthcare administrator, who thinks he has a passion for writing, and hence uses his limited idle time to pen down his thoughts. No publishing house has yet made him any offers, so he has to now debate his opportunity costs.

Archya is presently pursuing a MBA (PGPX) from IIM, Ahmedabad.

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2 Replies to “Evaluating PPP Models in handling emergency healthcare services in India”

  1. Hello Archya, its a great news ur in IIM. I was just searching for PPP models, and their efficacies in healthcare when I stumbled upon your post. Can you give some insights on how PPP models can work in Public Health Settings, like in TB Control?

    1. PPP models can actually used to great benefits in healthcare activities. A lot of NGOs are also doing some great pathbreaking work in the field. There have been some startups with good potential. We can discuss this in details offline

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