An Overview of Indian Railway Health Services Dr A Prakash. Sr Professor, Health Management. Rly. Staff College. Vadodara.

THE SIZE IR – one of the largest in world Total Track – 111,599 Km (National Highways – 71,772 Km) No. of Stations – 7025 No. of Trains – (Passanger Trains – 7000)

THE HUMAN LOAD Total Passangers – 18 million per day Total Employees – 1.4 million Total Retired Employees – 0.32 million [ Employee + Retired Employee Family Streangth – 6.3 million ]

Indian Railways as a part of the Government of India is committed to the welfare of it's employees and clients.

ADMINISTRATIVE STRUCTURE Railway Board Zones X 16 CR / ER / NR / NER / NFR / SR / SCR / SER / WR / ECR / EcoR / NCR / NWR / SECR / SWR / WCR Divisions X 67 3 to 6 per zone

TOP STRUCTURE OF IR Minister of Railways (MR) MOSR I MOSR II Chairman Railway Board MS MT MM ME ML FC Director General Railway Health Services (Secretory to GOI)

HEALTH DIRECTORATE Director General Railway Health Service Executive Director (G) Executive Director (Plg) Director (H&FW) Director (IH)

ZONAL STRUCTURE General Manager Additional General Manager/s CMD – PHODs – COM / CME / CEE / FA&CAO....

HEALTH DEPARTMENT AT ZONE Chief Medical Director CHD – ACMD/DyCMD – MD – CMS ACHD/Sr DMO (Admin) – Clinicians

THE THREE TIER STRUCTURE Zonal / Central Hospital Divisional Hospital Subdivisional Hospital Health Unit

FUNCTIONS AT RAILWAY BOARD Policy making Organisational Planning Guidence & General Supervision of Technical aspects of Medical & Health Department Budget for Health Services New Projects Medical Equipment & Plant

FUNCTIONS AT ZONAL LEVEL Guidance & Supervision of Technical Nature within zone Procurement AMI M&P Budget demands for zone

INFRASTRUCTURE OF MEDICAL DEPARTMENT Hospitals – 125 Total Beds – Health Units – 586 Medical Officers – 2506 Visiting Consultants + PG Students – 1000 Paramedical + Housekeeping – 57000

DUTIES & RESPONSIBILITIES Industrial Medicine Attending Accidents & other incidents – 224/yr Attending travelling passanger – 24000/yr Preemployment medical examination – 67000/yr PME of serving employees – /yr Other examinations & Medical Boards Sick & Fit certifications of employees

DUTIES & RESPONSIBILITIES Industrial Medicine (contd) Water Supply sampling at Stations – 60000/yr (Bacteriological) & (Residual Chlorine) Food sampling – 6000/yr (under PFA) & (under quality control) Certifying fitness of perishable goods at stations Duties under Workmen's Compensation Act Duties under Factories Act (6 Production Units & 66 Other Workshops)

DUTIES & RESPONSIBILITIES Clinical Medicine Preventive Curative Promotive Rehabilitative At all levels  Primary Level  Secondary Level  Tertiary Level

LEVEL DISTRIBUTION Primary Level Secondary Level Tertiary Level 100% inhouse 95% inhouse & 5% from other govt / private hospitals 10% inhouse & 90% from other govt / private hospitals

7% of indoor cases get referred to govt / private hospitals (mostly private) mostly for complicated problems It consumes 14% of the health budget There are 150 such recognised private hospitals all over the country.

CLIENTS Employees – lakh assuming 4 members per family X 4 = lakh RELHS – 3.14 lakh assuming 2 members per family 3.14 X 2 = 6.28 lakh TOTAL = lakh

OUTPUT OPD attendence – 2.60 crore/yr Indoor admissions – 5.18 lakh/yr At Railway Hospitals – 4.72 lakh At Govt & Private Hospitals – 0.46 lakh Surgeries – Special – 3153 Major – Minor – 88332

RESULTS Crude Birth Rate – 9.82/1000 (National 26.1) Infant Mortality Rate – 13.76/1000 live births (National 70) Crude Death Rate – 1.35/1000 midyr population (National 8.7)

FINANCIAL OUTLAY Year Budget-Crore % of Total

IS IT JUSTIFIED ? Money value of IRMS work – OPD – 2.6 crore X 100/- = 260 crore IPD – 4.72 lakh X 25000/ = 1180 crore Major Operations – X 1.5 lakh = 643 crore Medical Examinations – 2 lakh X 3000 = 63 crore TOTAL = 2146 crore Less budget – 1103 crore IRMS saves more than 1043 crore per year

CONSTRAINTS IRMS is a GOI organisation --- Policy – supportive Rules – time consuming but protective Finance & Infrastructure – no constraint Manpower – is a limitation Hence innovative means required

AT HEALTH UNIT LEVEL Health Units more than 25 km from hospital tests from private labs on payment Hb, TLC, DLC, Blood Sugar, Blood Urea, Serum Bilirubin, Cholesterol Routine Urine & Stool ECG X ray – common films

AT HEALTH UNIT LEVEL Pilot Project of Road Mobile Medical Van Total – 16 (one in each zone) Will visit each way side station twicw per week Consultation & supply of medicine Common investigation Sick/Fit certificates Maternal & Child care & Immunisation Preventive Health Checkup & Health Education Checking sanitation & hygiene

AT DIVISIONAL LEVEL Honorary Visiting Specialist – 2 hrs per day; 6 days a week from private sector Specialist from private sector on case to case basis Technical staff on contract for vacant posts – even out of cadre strength (Bhubneshwar)

AT ZONAL LEVEL Cases required tertiary care – referred to empanelled private hospitals Inhouse development – Joint venture with private hospital (building, major machines from Rly & manpower, running from pvt) – Medical & Nursing Colleges on PPP

ACADEMIC ENVIRONMENT Many Rly hospital recognised for DNB by NBE Sr Residency programs CME's by Rly hospitals Several specialities have their railway forum under national bodies/association Sponsering for conferences & trainings Study leave

BIOGRAPHY OF A RLY MO ADMO – GP NPA 25% ++  4 yrs DMO – GP NPA 25% ++  5 yrs Sr DMO – GP NPA 25%++  4 yrs Sr DMO/SG – GP NPA 25%  7 yrs ACHD/ACMS – NPA 25%  On turn CMS/eq. - CMD

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MISSION STAEMENT Total Patient Satisfaction through Humane Approach & Shared Commitment of Every Single Doctor & Paramedic To Provide Quality Health Care using Modern & Cost-effective Techniques & Technologies

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