Decaying Manipur Health Care Delivery System - II
Incomplete 5 district hospitals under NLCPR, suggested treatment lines for improvement

Dr Th Suresh Singh *

New block of CCpur Hospital inaugurated on July 19 2014 :: Pix - DIPR

When I joined as DHS, there were funds allocated for the 5 district hospitals, namely, Tamenglong, Senapati, Ukhrul, Chandel and Jiribam. The approval was for 50 beds each. These were allotted under NLCPR (Non Lapsable Central Pool of Resources). In my 1st financial year i.e. March 2006, there was no sanction for this, hence it was not encashed. In the 2006-07 financial year, I had tried to obtain the sanction of these important hospitals. However, there are many objections from the finance deptt. and planning deptt. There were many to and fro questions and replies from the DONER Ministry (the monitoring agency of NLCPR fund) also.

Many questions were also answered from our Medical Directorate. However, the objections continued mainly from the finance and planning deptts. These were mostly useless and were objections merely for the sack of objections. When the file came up from the section occasionally, I saw those objections and thought that it is becoming another time consuming endless project. I also wondered whether this can really be executed in my time or not. Anyhow, I requested Dr. Pratap, Add. Director and i/c planning to pursue the matter.

From June to February, we were so busy in conduction of MBBS/BDS combine exam, entrance exam of paramedical courses, and exam and procedure for new recruits and DPC that the file of this 50-bedded district hospitals covering 5 districts were consigned to the background. Letter on, I found that queries continued, we answered, that was all. Hence, during that financial year, we could not obtain the sanction. To be very frank, that year was so busy for DPC that I just became fed up to attend to telephone calls from VIPs and VVIPs that you forget those things occasionally.

Hence, another year lapsed. Fortunately, this project is from the non-lapsable fund and hence can be carried forward to the next financial year. By financial year 2007-08, we were free from all new recruit procedures. I thought I could devote more time to other important works. However, up to June–August 2007, we were very busy for MBBS and other entrance exams that I could not devote extra attention to other routine works. The deptt. was all the more burdened in tackling the Bird Flu epidemic with house to house survey conducted during the same period.

For this particular project, quarries continued, replies were sent but no sanction was coming forth. I still remember around December/January, when the file came up, I felt unhappy as this was the only big project which could not be executed. Hence, I studied the file, digested it and came to the conclusion that it has to be encashed anyhow this time. I have developed my own independent opinion that those objections were petty and there is no valid argument in the various objections. Even if one take those objections to their face value, those can be answered and tackled latter on. The construction should start by encashing the 1st allotment, I opined. Mind you, it was a topic for discussion in every Cabinet Meeting also.

Accordingly, I took the file to the then Finance Commissioner R.R.Rasmi and explained the position that this had been lying on for the last 3-4 years because of unnecessary objections. I also told him that, 'Sir, I want to encash it anyway in the present financial year'. I was surprised to hear his reply – 'Dr. Sahab, who told you that it could not be encashed'? You put up the file. I was so surprised and happy that I told him I would bring the file personally for approval. I then went to our Principal Secretary (P.S), Health, Shree D.S.Punia and told about the Finance Secretary's nod and requested him to help.

Aftermath was easy. Back to the office, I asked the section to put up a draft immediately. After modification, it was sent to the Principal Secretary, Health, with a Deputy Director earmarked for it. He was asked to report to me when the file reached our principal Secretary so that I could take it from him direct to the Finance Commissioner R.R.Rashmi. When it reached D.S. Punia (P.S), I went to him, took his signature and then took the file direct to FC R.R. Rashmi. He readily signed his approval in my presence. I took the file personally, interred it in the register of his PA and then asked my accompanying Deputy Director to take it to finance section for sending it back to Sectt. Health section. That evening, in my office, we had a gathering for accomplishing an important task lying un-fulfilled for a long time. Later on, we got the sanction order. It was encashed and then deposited in 8449 State Account.

The amount deposited was Rs 22.49 crore. The total project cost was Rs 64.26 crore which is subject to revision from time to time. An interesting facet was that this was laying unencashed for last 2 financial years (2 different DHS). Another 1 yr was lost during my period. If somehow, anybody asked me my most disappointment thing during my tenure, it was this loss of one year. Anyhow, it was compensated with this last act of labour. I feel happy about that. For every district hospital, it was around Rs 4.5 crores each.

Since I joined, other activities of these district hospitals were continuing – site identification and acquisition, approach road identification and acquisition, actual acquisition of Patta in the name of Health Deptt., modified structure planning etc. It was easiest for Senapati in view of the personal interest taken by the then MLA and ex-Minister Franchis Nganjokpa. A 10 acre was earmarked without difficulty. For Chandel also, there was no problem as it is to be constructed within the present hospital complex. For Tamenglong, a 7 acre land was already earmarked at Duigailong. Formalisation of the site problem was solved by the good initiative of the then Health Commissioner Mr. Golmei who belonged to the region. The most difficult was for Ukhrul where it was planned to sift to Hundung from the present hospital complex.

It required intervention both from CM and CS at the highest level. Finally it was settled by giving the minimum compensation to the local authority and we got 7 acre earmarked. For Jiribam, though land was available, it could not be finalised in spite of personal intervention by Hon,ble Revenue Minister Th. Devendra. Finally, I and our team had a joint visit to Jiribam with the Hon'ble Minister, surveyed and fixed the area. I convinced the Hon'ble Minister to allot more than the already proposed one. The area should be a bigger one as the deptt. was planning to expand it to a 100-beded one in future.

The Minister is my cousin brother from my wife's side. Hence, I can visit his office any time without prior appointment for all land allocation of the deptt. I also stayed in his house during this visit. The Minister was happy, convinced and readily agreed to the proposal. I personally selected the area; it was the best site selected. Every intended work could be executed including the proposed future expansion to 100-beded one.

The area earmarked was 10 acre (exact is 9.94 acre) at Aglapur (Harinagar) with further scope for expansion. I was so happy and had that internal satisfaction as if I had cleared a difficult exam. Many important buildings/deptts. are coming up there. I am sure the area will become a VVIP area in the not so a distant future. Though the minister was telling me that he would give further allotment if needed, I am sure it will be difficult to obtain in future. This area of 10 acre was double the land of what was originally planned by our deptt. If properly developed, the hospital should serve as the catchment area of Tamenglong district also. These are the various activities performed by my deptt. during that short tenure of 2 yrs. and 2 months. What more can a poor DHS do other than this?

After effects : When everything was kept sand-witched ready to eat, the progress was very slow and not to the mark after I left. Enquiries from my colleagues and other agencies about the latest position shows that only Senapati is the progressed one and inaugurated on 1st July this year (2014). Jiribam also is about 90% complete, Tamenglong is also complete about 80%. Ukhrul and Chandel had the worst with about 70 and 60% completion respectively. The question is why these important hospitals are not functioning even after 7yrs. the 1st sanction money was encashed? How long will it take? If the situation is so, what is happening to our health care delivery system? Everybody is to be worried about this. From the sideline, I also felt very unhappy and sad as I had my share of contribution.

What is the remedy ? Principal cause is failure of the monitoring mechanism. Being the owner, DHS has to take the bigger slide of the blame. He has to run here and there as shown in the above various activities. A DHS must know how to coordinate, how to monitor, how to manage finance. He has to coordinate with the 5 construction agencies namely, PDA, MDS, DRDA, DC EC cell-11 and PWD. Sometimes you have to threaten the Engineers and the Contractors that further money will not be sanctioned if satisfactory progress is not executed. The DHS has to go to Health secretary, the Minister, CS and CM. I still remember my more than 10 times personal visit to Planning deptt., PWD and Joint Secretary level Secretariat finance section each. Not only this, he is too meet local MLAs/ministers seeking their help to solve problems in their area. Fortunately, every MLA/Minister is ever ready to help the Health Director for any problem in their area as the deptt. is very attractive for vote-catching. In fact, many of them will come to DHS requesting/asking something. He has to take advantage of that.

For these hospitals, we need specialist doctors, nurses and other para-medical staff. We also require various equipments and investigation facilities. Did the deptt. has planned it? I doubt it very much. Are we to consign our fate as is happening now? These are the worrying scenes. But is there anyone who listen to it?

Running Health Deptt. is not an easy one. This is probably the 2nd busiest after Home Deptt. I used to dispose of about 50 files on daily basis. Other deptts./sections just don't care for us. This is the work culture seen throughout our state. Nobody thinks that the coming up hospitals will one day save his/ relative's precious life. You only find a hue and cry when some unfortunate patients die suddenly. One has to take running this deptt. as his own personal business. Only then, one can deliver something good for the state. These are some of the management Mantras I learned and practised as a student of Health Administration. Many more are coming, have patience.