Primary Health Care Under ESI Scheme

1

Round Table Conference

On

Primary Health Care under ESI Scheme

[May 20th2015; Manesar, Haryana]

Report on proceedings

Round Table Conference to discuss the issues concerning primary health care under ESI Scheme was organised on 20th May 2015 by Delhi/NCR Chapter of Social Security Association of India in collaboration with Friedrich Ebert Stiftung, Delhi. It was a daylong conference of practicing physicians from ESIC and the State Government of Haryana, Social Security Administrators, Trade Union Leaders, Employers’ Representatives, Social Activists drawn from various parts of the country. The conference was chaired by Dr. A.K.Balyan, Working President, SSAI. Dr. Praveen Sinha, Senior Advisor, FES was the Chief Guest on the occasion.

2.Opening the consultation, Mr. B. N. Som, Secretary General – Social Security Association of India [SSAI] health care is one of the primary needs of an individual. Accordingly, as early as 1948, India enacted the Employees State insurance Act with a view to provide comprehensive social security to workers. The benefits provided under the ESI Scheme include sickness, disablement/dependent pension, maternity and medical benefits. Of recent there has been concerns expressed about the working of the ESI as also on delivery of benefits to insured persons [IPs]. The present consultation, that has presence of ESI officials, medical doctors, trade union representatives as also employers is aimed at critically examining the existing scenario and to suggest strategies for efficient deliveries of the benefits to IPs, said Mr. Som.

3.Dr. Navneet Singh, Director [Emergency Services] of Rockland Hospital expressed dissatisfaction with the delivery services of ESI hospitals. The ESIC has, no doubt, developed impressive infrastructure, but there are neither doctors nor sufficient availability of medicines resultantly patients are not going to ESI hospital. They request for being referred to ESI connected private hospitals. There is also disconnect between ESI and state government health services network.

4.Dr. Pravin Sinha of FES expressed that the ESIC health of the people must remain the primary concern. The Government of India is thinking of providing health care for all. To achieve this it is imperative that the existing infrastructure as also human resource is made efficient. The existing gaps needs to be identified and bridged. ESI services must move away from mechanical mode to humane mode and create an inviting environment. There should be cohesion between the ESI hospital and state medical services. A system of frequent dialogue among all arms of services deliveries be activated.

5.Mr Murli K Jha, Vice-President,AITUC,Haryana in his opening address shared his experience and stated that primary health centres are primarily designed to prevent diseases but seldom that objective seemed to be fulfilled by the authorities. For example, out of 18 dispensaries established in the State only 12 are functional; and those which are functioning are suffering from lack of physical facilities and financial resource crunch. Haryana Government receives Rs 1500 per IP as annual expense but per IP spend has not gone above Rs 950 so far.The dispensaries which are functioning are mostly functioning in dilapidated buildings, driving the IPs away and creating unhygienic condition at workplace. The need of the hour is to revamp the medical administration to energise the system of delivery of services, calling for greater coordination between ESIC and the concerned State government for this purpose.

6.Michael Dias, Secretary, Employers Federation of India – Delhi as also Member of ESIC Board felt that a time has come when the ESIC must undergo major structure change by shifting power base to the state governments. ESI contributions comes from employers and workers and the state governments are primarily the delivery agents; yet the control is vested with the ESIC-impacting the working of the ESI facilities. ESIC, as an organisation, works in two different silos, as it were –one, revenue silo and the other, medical silo. ESIC focus must shift from revenue generation to service delivery to IPs. The MSME [medical services and medical education] should be undertaken seriously. Measures also needs to be taken to encourage state governments to pay their outstanding dues to ESIC, said Mr. Dias.

7.Dr. Gopinath, Dy. Director – Medical Services of the Government of Haryana was of the view that there was insufficient supply of medicines. Investigators were also not available in required numbers. Most of the government hospitals in the State did not have ambulances. However, it would be wrong to say that there is deficient medical services in the State.

8.Dr. [Mrs.] Sadhna Yadav, Civil surgeon, Gurgaon articulated that there was insufficient infrastructure to provide basic health services. Doctors do not have decent work place to operate as most of the health centres are located in rented accommodations. The patient examination facilities too are lacking. There is only one ambulance for the whole of Gurgaon which is growing very rapidly. She felt that basic level of infrastructure for opening a medical centre be defined and each centre be provided with mobile van.

9.Opening the Consultation, Dr. A. K. Balyan, CMD- PETRONET and Vice President, SSAI, opined that one need to have macro view as health care had direct bearing with the national wellbeing. The Government of India’s Universal Health Scheme is on the line of Obama Care of USA, as such the UHS should be discussed in detail. Medical doctor’s reluctance to serve in rural India be dealt with all seriousness by either making the same mandatory [in the form of internship or houseman-ship] or the doctors should be given hardship allowance. There is need to examine as to why the health care facilities have not developed at many places, including in Gurgaon, since money is not a constraint. Dr. Balyan opined that the approach to rendering medical services by the ESI staff needed to have a relook to identify the service deficiencies as also whether the attitude of ESI staff wascomfortable towards the IPs.He felt that ESIC/State Govts should think of taking help of CSR fund of the Corporates for making good the deficiencies, like, provisioning of mobile service facility, ambulance service and so on and setting up connectivity among the various primary centres. In conclusion, Dr. Balyan suggested that medical treatment should receive priority in ESIC system and not revenue generation; there should be more use of technology to offset the human resource gaps; ESI facilities should develop close linkage with other units engaged in the delivery of health care services; as also immediate sensitization of medical doctors through frequent training and education.

11. The consultation had three technical sessions focused on the issues of [1] evaluation of primary health care system of ESIC; [ii] Problems and challenges facing the primary health care services; [iii] stake holders’ panel discussion on primary health care.

10.Speaking during the first technical session on the evaluation of ESIC’s primary health schemes, Dr. Lalita of the Senior State Medical Commissioner’s Office of the Government of Haryana said that they were essentially concerned with the secondary health care and preventive health care. She was of the opinion that an IP should not be travelling a long distance to receive health care. She also felt that the employers should render support to the system by providing basic medical facilities at the factory itself. Such a move would not only reduce the chances of a worker taking leave to go to hospital but would also reduce load on the state health machinery. Food supplements be supplied at the workplace itself. She further suggested that the factory management should request ESI for frequent medical checkups so as to address the sickness at the initial stage only. Need for better coordination between ESI hospitals / clinics and state primary health centres was also expressed. Employers’ representative expressed that theworkers, especially in the garment industry, would not be interested in getting themselves registered since their employment with a particular employer was of temporary nature. Michael Dias opined that the employers might notbe coming forward to take the responsibility of providing medical / food supplement facilities. B. N. Som suggested that the employers could get the cost of providing such services reimbursed from the ESIC. The Medical Superintendent of ESI Hospital in Gurgaon, Dr. Kalyan Singh, said that the ESI schemes be made attractive by ensuring increased available of services at easily reachable locations. There should be a check on referrals by well equipping the local units since lack such a facility negatively impacted the image of the ESI services. Similar view was expressed by Dr. Anju Agnihotri, MS – ESI Hospital, Manesar, Haryana. She said that in the absence of adequate medicines, the capabilities of the medical centres were notbeing fully utilised. The employees don’t want to interact with ESI facility as they have low opinion about its working efficacy. She said that to redeem the situationthe primary health centres must be adequately equipped to undertake blood checkups; kidney function tests; BP, blood sugar tests, etc. Dr. D. K. Mishra, Director, ESIC-Gurgaon said that the behaviour of ESI doctors and other staff were perceived as unfriendly as such patients did nothave confidence in ESI services. Dr. A. M. Raju of SSAI said that the multiplicity of schemes is creating major hurdle. Further, that primary health care under ESI Scheme be made Central government’s rather than State government’s responsibility. He floated the idea of starting a public heath worker’s cadre on the lines of central civil services. Concluding the first session, Dr. Balyan said that it was not easy to make affordable health care for all. Nevertheless, one need to ensure that ESIC’s objective of rendering medical benefits to IP was realised. The IPs must be made comfortable while receiving medical benefits from ESIC. To this effect SSAI must organise awareness programs about ESIC and its schemes.

11.1Chairing the second session focusing on problems and challenges being faced by primary health care services under ESI Scheme, Mr B N Som requested thatMr Virjesh Upadhaya, General Secretay, Bharatiya Mazdoor Sangh[BMS] to initiate the discussion. Mr. Virjesh Upadhyay in his presentation said that the Indianhealth scenario,vis a vis the industrial workers, has under gone a sea change changed from the one that had existed in 1948. As for workers, once they make their contribution to ESIC, they expect services from ESIC as promised. Workers have low confidence in ESIC services as also in level the behaviour of the ESIC staff. The behaviour standard in the tie-up hospitals too was not encouraging. While advocating remedial measures to revamp the medical system, he also called forbringing the informal sector workers within the fold of ESI Scheme.He felt that ESIC should draw lessons from the better working institutions in governmental sector itself, such as, Railways and Defence. Measures also need to be initiated to merge all the schemes into one so as to provide comprehensive coverage to all workers irrespective of whether they were employed in the formal or informal sector. Bro. Upadhyay also called for removing political influence over functioning of ESIC and suggested that trade unions be engaged in the management of the ESIC affaires.

11.2 Prof. A. K. Khokhar made a presentation aimed at the social aspect of services delivery. He felt that the medical doctors be trained to handle patient sensitively even in difficult situations. Other forms of medicine, e.g. ayurveda, homoeopathy, naturopathy, be also looked into.

11.3 The employers’ representatives, Mr. Michael Dias, also felt that ESI hospital services though one of the best in country, was not being properly projected. There was disproportionate distribution of manpower as no one wants to go to rural areas. ESIC has to walk the talk and must fill the existing vacancies, he said. He also pressed for establishment of diagnosticcentres at all ESI treatment centres. Som felt that model dispensaries be linked to ESI hospitals.

12.Chairing the concluding session, Dr. Pravin Sinha said that there seems to be problem in the delivery of services as also gap between demand for ESI services from the IPs and its availability. To attract IPs, it is mandatory that the IPs are aware about the ESI hospital facilities. There is expressed need to bring about change in attitude of ESIC employees with focus on services providing. He congratulated the NCR Chapter of SSAI and in particular its President Mr. S. C. Verna and Secretary Mr. Pranay Sinha for successfully organising the consultation.

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