Identification of gaps in implementation of Ex-servicemen Contributory Health Scheme (ECHS) and suggest possible avenues for improving the same S.P. Jain Institute of Management and Research J&K ‘SAI STAR‘ Society S.P. Jain Institute of Management and Research Sai STAR -DOCC Project 5 th March, 2013 – 14 th April, 2013 By MBA Students of SPJIMR & J&K Sai Star Society Under the Guidance of Brig Amarjit Randwal (Retd) 2013

About the NGO - J&K ‘SAI STAR’ Society 1of6 1 9 Mission Vision Values To improve the quality of life of rural population by sustainable development at grass root level. Inclusive development by working at grass root level and employing sustainable technologies and information with regard to Healthcare, Education, Agriculture: Correct use of natural resources and environment with special emphasis on empowerment of Women, Children and Welfare of ex-servicemen and widows. Honesty, Integrity, Innovation, Sincerity and Hard work Established by Brigadier Amarjit Singh Randwal (Retd) in March 2004 Works for the rural development in areas of Udhampur and Kathua district - Jammu Current Organizational Structure Member of UN Global Compact - adhering to the principle of Anti-Corruption Healthcare 3600 people treated during medical camps organized in villages Society ambulance for evacuation of serious cases Education Runs Sainik Star Primary School to provide quality education to poor children Art and Craft, Tailoring courses for rural women Welfare of Ex-Servicemen 464 Pension related cases settled through ESM Helpline Provides CSD Facilities to Ex-Servicemen within the area Key Areas of Work

1of6 2 About ECHS – Ex-Servicemen Contributory Health Scheme Started on 1 st April, 2003 to provide Comprehensive and Quality medical care to Ex-Servicemen and their Dependants Lakhs Total number of beneficiaries under the scheme Lakhs Total number of beneficiaries under the scheme Concept of ECHS Lack of necessary resources Reasons behind formation of the scheme Inadequate Fixed Monthly Allowance Cap on treatment at Military Hospital Inaccessibility of Military Hospital Existing Infrastructure Command Hospitals Control Structure Spare capacity - Service Medical facilities Procurement Organizations Defence Land and Buildings Augmented Infrastructure Armed Forces Polyclinics Augmenting Existing Medical Facilities/Clinics Outsourcing Government Hospitals Civil Hospitals Diagnostic Centres Rs Crores Annual budget for FY Rs Crores Annual budget for FY Started on lines of Central Government Health Scheme (CGHS) Scheme is financed by Government of India, One Time Contribution from ESM and from Army Welfare Fund.

1of6 3 Details of the Project 1.Interaction with various stakeholders 2.Field Visits to various types of Polyclinics 3.Secondary research 4.Comparison with other prevalent schemes Ex-Servicemen and their Dependants – Lakh as of January, 2013 Identification of gaps in implementation of Ex-servicemen Contributory Health Scheme (ECHS) and suggest possible avenues for improving the same 1.Understanding ECHS, its functioning & policy framework 2.Key stakeholders & their perspective regarding the scheme 3.Key areas for improvement 4.Feasibility study of the proposal to reorganize the current organizational structure For effective Data Management of NGO – A Dashboard was designed and implemented to suit their requirements for managing the details of Ex-Servicemen and beneficiaries. 9

Macro Level Problems Lack of System Ownership and Dilution of Accountability Inadequate Authorization of Manpower Procedure for Empanelment ECHS Helpline Assessment - Findings and Analysis 1of6 4 Ground Level Problems Lack of Awareness Staffing Problem Procurement of Medicines Delays in Bill Processing Suspected Unethical Practices in the System Absence of Effective Grievance Redressal System Findings are based on the Interviews with stakeholders – Policy Makers, Beneficiaries and Implementers of the Scheme, Secondary Research, Field Visits to various Polyclinics and Central Organization, ECHS. 9

Recommendations - Ground & Macro Level 1of6 5 Lack of Awareness OIC to be given additional responsibility Advertisements on National Television and Radio Staffing Problem Review Payment Terms of Contractual Employees annually. Starting up of ITI on the lines of AFMC Procurement of Medicines Procurement via tender for each Regional Centre Delays in Bill Processing Demographic Concealment Reorganize the structure to eliminate the role of SEMO Cash Discounts Suspected Unethical Practices in the System Separate Vigilance Department at each of the 28 Regional Centres Absence of Effective Grievance Redressal System Formalize the Electronic Complaint Resolution Management System For Awareness, use LCD screens at polyclinics to flash information about e-CRMS Lack of System Ownership and Dilution of Accountability Vest more powers with the Central Organization, ECHS. Central Organization to be made responsible for the management of funds once the budget is approved by MoD. Inadequate Authorization of Manpower Allocate the manpower in polyclinics as per the sick report Procedure for Empanelment Streamline the process of Empanelment Reduce the performance bank Guarantee for rural and semi- urban areas ECHS Helpline Flash the helpline details on LCD setup in polyclinics To provide Single Point of Contact 24x7 hotline number for emergency purposes 9 OIC – Officer in Charge SEMO – Senior Executive Medical Officer AFMC – Armed Forces Medical College MoD – Ministry of Defence CRMS – Complaint Resolution Management System

1of66 Recommendations - General Immediate Measures Ease out the Referral Process ECHS Contribution from Navy and Air Force Welfare Fund as well Provision for suitable Transport Vehicle for Non-military Polyclinics Short Term Measures New Medical Procedures Literacy of Staff at Polyclinics OIC EHCS – Annual Training Regular Meeting with Regional Center Long Term Measures Eliminating the role of SEMO and Station Headquarter. Comprehensive use of Automation within ECHS Reorganization of ECHS as an Independent Body (Within 1 Year)(Within 2-4 Years)(Within 5-8 Years) 9

1of67 Project Experience and Takeaways 9 Too many cooks spoil the broth If too many people try to take charge of a task, the end product might be ruined. Success of the Project is directly proportional to its Effective Implementation. Ineffective Implementation can lead a good planned project to failure You cannot manage what you cannot measure Lack of effective ways to measure efficiency can lead to mismanagement When solving problems, dig at the roots instead of just hacking at the leaves Important to analyze problem at the grass root level and macro as well Your most unhappy customers are your greatest source of learning. How to improve the system. Everything we do is a process that can always be improved. There is always scope to improve a system  Working in an informal setup  Hospitality of rural people  Information about functioning of Army  Things which we take for granted are luxuries for Rural India  Working in an informal setup  Hospitality of rural people  Information about functioning of Army  Things which we take for granted are luxuries for Rural India DOCC Project ECHS

1of68 Appreciation 9 The study on ECHS got published in State Times of Billawar

“Healthy Citizens are the greatest asset any country can have” -Winston Churchill

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