Dr. Vijay Rai, MD Additional Director Directorate of Health Services Govt. of NCT of Delhi

1. Scaling of best practices: An answer to the challenges confronting public health systemSharing Experiences of a 100-bedded Delhi Hospital serving the poor Dr. Vijay Rai, MD Additional Director Directorate of Health Services Govt. of NCT of Delhi

2. Amartya Sen on State of Public health in India • Spoke in 11th Kolkata Group workshop organized by Pratichi (India) Trust, Harvard Global Equity Initiative and UNICEF India • “The state of health care is dismal…relying on private medical care, without the availability of public health services, allows extensive exploitation of vulnerable and under-informed patients and their families, because of asymmetric nature of healthcare knowledge” • “We are not against private health care, but it shouldn’t take the place of public health care services”

3. State of Health in India • Progress has been made in health delivery in India but gaps exist • Primary health care infrastructure expanded but a significant number of PHC’s and sub-centers unable to perform. • Substantial improvement in health status in past few decades but still miles to go. • Strategic initiatives under NRHM: • Flexible funds • ASHA, JSY, JSSK, IDSP, IMNCI • Improvement of health infrastructure

4. Challenges before the Public Health Delivery System of Delhi • Unmet demand: • Equity and access • Over-crowding Vs. Poor utilization • Increasing population: Need for more hospital beds • Quality issues • Resource mismatch: • Human Resource Issues • Technology use • Funding • Management model • Linkages among health institutions • Standards and Accreditation

5. Challenges of Public Hospitals in Delhi • Overcrowding • Bed Occupancy more than 100% • Heavy demand on Resources: • All Services Free • Human Resource Issues • Lack of trained manpower & vacancies • Low retention • Managerial Issues & Decision Making • Design Issues leading to stress on care providers and the patients

6. Case of Guru Gobind Singh Govt. Hospital, Raghubir Nagar • 100 bedded multi-specialty hospital • Services: • OPD & Special Clinics • Emergency Services (Casualty, delivery room, OT and Lab) • Indoor Services & Newborn Nursery • Operation Theaters + Delivery room • Clinical Services in common specialties

7. GGSG Hospital Contd. • Surrounded by resettlement colonies • Daily OPD Attendance: 1600-1800 • Average Bed Occupancy: >100% • Reasonably good infrastructure in terms of space and Hospital Design • Daily Surgeries (Major + minor): 60 • Lab Tests per day: 1200 • Running Casualty, Emergency & delivery room services

8. Some Historical Facts about GGSGH • Established in the resettlement colony of Raghubir Nagar, West Delhi under the "Special Component plan“ • Surrounded by about 10,000 JJ clusters • Poor sanitation, filthy environment • Became operational in 1995 with just OPD Services on public demand • Staff strength: 33 • Mostly diverted from nearby dispensaries

9. Challenges of GGSG Hospital Administration- 1997 • Filthy surroundings • Stalled construction of Indoor and OT blocks • Dispute between contractor and PWD • Overcrowding • Poor infrastructure • Electric Power, water, Sanitation • Poor motivation of the staff • Limited Financial Powers of MS • Stiff targets: to commission indoor, Lab & OT services in a year

10. Strategies to meet the challenges 1997 1 • Apprising the ground realties to the Govt. and seeking support • "Team First” Approach: • Hope: Things are bad but lets try to do something about it so long we are here • Importance to personnel & Ownership • Delegating work: Choosing the right person for the right job • Multi-tasking: Importance of nurses • Identifying the ‘believers’ and converting them into champions

11. Strategies to meet the challenges - 1997 2 • Improving Infrastructure: • Interactions with PWD: Resolve disputes, obtain more power and water • Creating new branches to deal with planning with focus on manpower and equipment planning • Strengthening store & purchase • Introduction of a computer

12. Strategies to meet the challenges: 1998-99 3 • Adding services: Think big, start small! • Casualty & DTU: Beginning of emergency & indoor services • Physiotherapy and Minor OT • Dental wing • Radiology Services & DOT Center • Increase in staff to 200; • In-house recruitment for nurses and JR/SR • Outsourced ancillary services • Indoor services with 25 beds and MRD

13. Strategies to meet the challenges 2000 4 • Using Information Technology • Training of staff in IT • LAN with 40 nodes: Support of IT Dept. • Computerized OPD registration • Budget, Pay roll and Inventory Management on computers

14. Outcomes! • GGSGH is the first public hospital • to have computerized its OPD registration way back in year 2000 • to have computerized all its services as a pilot project through a LAN with >100 nodes and a modular H.I.M.S. software • to have commissioned all its major services in less than five years and now at the verge of adding 100 more beds • One of the team members of 1998 is now the MS of the hospital with full powers of an HOD

15. Acknowledgement! • This presentation is inspired by doctors and nurses who were members of the GGSGH Team 1997 several of who continue to play an important role there. • Presently the GGSG Hospital administration is led by one of this team members Dr. S. C. Chetalwho is now the Medical Supdt. • I acknowledge his valuable inputs to this presentation. -Dr.VijayRai

16. Thanks for your attention!