Name of Presenter: Rishi Riddha Anahata Position/Company : Secretary

1. Ambulance Services in Rural Hospitals (RH) and Block Primary Health Centers (BPHC) in West Bengal, India Name of Presenter: Rishi Riddha Anahata Position/Company : Secretary Matribedi Shamayita Math (NGO) District: Bankura, West Bengal, India

2. Context – Overview of the project Emergency transport scheme (ambulance services) in RHs and BPHCs introduced by Government of West Bengal (GoWB) through the operational management of NGOs/CBOs under PPP to provide: Round the clock ambulance services at remote places benefiting the population at large at user charges fixed by the District level authorities Speedier transportation of accident and other critical cases Transportation of Delivery cases facilitating institutional deliveries Cashless delivery transportation to the mothers through voucher scheme under Janani Surakha Yojna (JSY) scheme – a means to ensure institutional delivery (Voucher scheme was introduced subsequent to the original scheme)

3. Type of PPP The ambulance equipped with Oxygen Cylinder, stretcher and IV stand provided by GoWB under Indo German Basic Health Project to the NGOs/CBOs selected based on eligibility criteria on contractual terms. Ownership remains with GoWB. NGOs are the operating partners. All operational expenses borne by the NGOs. Insurance premium provided by GoWB NGOs collect user charges fixed by concerned authorities of GoWB in each District to meet the operational cost. The ambulance operates from the allocated RH/BPHC and transports patients from the RH/BPHC as well as from the residence within the Block . NGOs comply with the SOPs incorporated in the scheme.

4. Partnership/Actors Involved Public Partner: Health & Family Welfare Dept, GoWB (Agreement signed with the Chief Medical Officer of Health of the concerned District, GoWB) Private Partner: NGOs (In the District of Bankura, Matribedi Shamayita Math was selected for operating ambulance services at Amarkanan RH and Kanchanpur BPHC) Other Actors: Consultants (during the set up and up to the initial phase of post operationalisation of the scheme)

5. Project Objective Enabling the rural population to reach the Health facilities at the earliest in case of emergency Round the clock services at uniform user charges for the benefit of patients at remote places, where transportation at night is difficult Transportation of delivery cases to facilitate institutional delivery and subsequent introduction of the benefit of voucher scheme for cashless delivery transportation Speedier transportation of accident and other critical cases to higher tier hospitals as patients can be directly transported to these hospitals under this scheme

6. Project Set-Up and Arrangements Agreement on contractual terms signed with the CMOH of Bankura District, GoWB after selection as the operating partner. Orientation programme undertaken by GoWB through Consultants explaining the scheme and SOPs The ambulance , provided by GoWB was placed in the allocated RH/BPHC Mass campaigning of the project throughout the block through field level worker, ANM of the sub –centres Cell number of the driver circulated and also provided in the Ambulance Display boards on ambulance services in every sub-centres /PHC of the block

7. Key Milestones Transportation of Delivery cases to contribute to increased institutional deliveries Considerable saving of time and efforts of patients and their relatives in rural areas to get ambulance services. Better security and safety of patients in remote areas during transportation. Round the clock services at uniform rates

8. Challenges and Mitigation Plans Challenges : Resistance from the local private car owners Lack of proper support in the initial stage at the Block level The rate, fixed initially by GoWB, was marginal for sustainability in view of increase in cost of fuel. Mitigation Plans : Mutual discussion along with the Block Medical Officer of Health (BMOH) of the health facility with the local private car owners Mass awareness on the benefits of PPP ambulance e.g round the clock services at uniform rates Interactions with CMOHs and coordination with BMOHs on issues like rates etc

9. Progress to Date Boththe Ambulances are in operation Patient coverage of the ambulance for Amarkanan RH in particular was commendable compared to other RH/BPHCs in the District in the financial years 2009-10 & 10-11 In view of marked increase in the demand for ambulance services, a second ambulance was launched by us in 2009-10 The voucher scheme under JSY for cashless delivery transportation further contributed to the increase in patient coverage

10. Lessons Learnt Increased awareness of the local people on the benefits of the scheme helpful for greater utilization of the ambulance services Need for regular interaction by both the partners at local level in resolving operational issues Review of the user charges based on operational expenses at regular interval important for running the programme in a sustainable manner Sharing of good performances and success stories amongst all the operating partners in District level meeting time to time helpful to bring in more success.

11. THANK YOU