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At the OPD, a Cinderella story

When Nageshwari Devi (35) was told that her only child, six-year-old Dharmender, had a tumour in the stomach that had to be surgically removed, she immediately began packing for a 110-kilometre journey from her home in Bulandshahar, Uttar Pradesh, to Delhi. She wasn't headed for the renowned All India Institute of Medical Sciences or even the famed Ram Manohar Lohia Hospital.

delhi Updated: Jul 13, 2009 22:15 IST
Jaya Shroff Bhalla

Delhi is offering additional funds to hospitals that meet international standards. And it's changing the face of healthcare in the city, with people from UP and Haryana travelling miles for doctors that smile and floors that sparkle

When Nageshwari Devi (35) was told that her only child, six-year-old Dharmender, had a tumour in the stomach that had to be surgically removed, she immediately began packing for a 110-kilometre journey from her home in Bulandshahar, Uttar Pradesh, to Delhi.

She wasn't headed for the renowned All India Institute of Medical Sciences or even the famed Ram Manohar Lohia Hospital.

Instead, she asked her brother-in-law to get out his motorcycle and drive them to East Delhi. There, they wended their way through the narrow bylanes and past rickety streetside stalls to the Chacha Nehru Bal

It is India's only government healthcare facility to have received the internationally recognised Quality Council of India accreditation.

"Many hospitals have big names and reputations," says Devi, a homemaker and wife of a reasonably well-off farmer. "But when you go there, the doctors don't care… the place is filthy."

Devi says she heard about the Chacha Nehru hospital from a relative. "She told me it was clean and the doctors were kind and attentive. I was determined that my son be treated there."

It's not hard to see why. The hospital is bright, airy and spotless - yes, even the floors. Cheerful posters use fairy tale images and cartoon characters to explain the importance of inoculation, hygiene and birth control.

The staff is trained to be friendly; doctors are attentive, listen - and smile.

"The smiles have a taken a little long to come, but they finally have kicked in," says medical superintendent Dr K K Kalra (55), the man behind the transformation. "We had a year-long training programme before the accreditation and we taught them to be more sensitive."

If the doctors smiling is unusual, the patients' smiles are even more so. Most government hospitals across the country are unclean and understaffed. The overworked doctors are sullen, there are patients lying in the corridors and the less said about the kitchens, the better.

Hygiene is so compromised that a 2006 World Health Organization study found that one in every four patients at government hospitals developed infections other than they ailment they were admitted for.

Nevertheless, the money keeps pouring in. There are no regular inspections, no set standards.

"As and when money is required, we sanction funds, be it for additional staff or supplies or equipment," says Delhi Health Secretary J P Singh. "Now we are trying to rope in international bodies to conduct workshops to help improve conditions."

Here's what we suggest: Link Central funding to quality certifications, thus pushing all hospitals to aspire to global standards of healthcare. Offer fiscal incentives to hospitals willing to make the necessary changes, as Delhi - and Gujarat and Kerala - have done.

The impact of such a move would change the lives of millions of urban poor - currently, close to the 25 per cent of the population does not seek medical care because they cannot afford it.

The change would also be sustainable, since the quality ratings are reviewed every three years.
In Delhi, the state government signed up with Quality Council of India in 2007, with the eventual aim of having all 41 government hospitals in the state certified by 2010.

That may have been a bit ambitious - only one has been certified so far, and two others are almost there. But there are additional funds on offer if you want to spruce up your hospital, and the scramble for accreditation has seen standards soar in many other hospitals.

For instance, the Maulana Azad Institute of Dental Sciences in central Delhi, one of the two hospitals aiming for accreditation, now maintains digitised records of every patient, so their files will be available if they visit the hospital again. Most government hospitals have absolutely no system of maintaining patient records.

At Chacha Nehru, where the wards had been closed for over a year because there were not enough doctors, the dingy décor has been replaced by state-of-the-art, colourful interiors - and a flood of satisfied customers. The 216-bed hospital now gets up to 500 little patients a day, up from less than 300 just a year ago.

The key to this change, says Dr Kalra, is outsourcing.

"I have outsourced every support service - sanitation, accounts, data management, kitchen, even horticulture," he says.

That leaves the hospital to take care of its core competency: Caring for the sick. And, of course, keeping an eagle eye on the service providers. For instance, Chacha Nehru is one of only a handful of hospitals to preserve samples of all hospital-cooked food for 24 hours.

"This helps us to go back and investigate in case there is ever a problem," says Kalra. The change wasn't quick, or easy.

"Accreditation is a long process and may take up to nine months," says QCI Deputy Director Dr B K Rana. "We examine everything from physical infrastructure to staff strength, training, sensitisation and even maintenance of equipment and instruments."

In India, only 34 hospitals have been granted accreditation. All of them are private, except this one.
The QCI is, however, working with government hospitals in several states, including Gujarat, Tamil Nadu and Kerala, to get more facilities accredited.

At the Chacha Nehru hospital, Nageshwari Devi's son Dharmender Kumar is recovering well and looks comfortable in his bed in the Intensive Critical Care Unit.

In the next bed, Deepmala Devi (25), a salesman's wife from Haryana, watches over her 14-month-old boy Sunny, admitted with a chest infection.

"When I first got here, I was so worried, I could barely breathe," she says, stroking the boy's head. "But the doctors and nurses were so reassuring. They answered all our questions patiently and check on my boy all the time. I just wish all hospitals could be like this."

The problem

Most government hospitals are overcrowded, understaffed and poorly managed, seen as only a last resort even by the poorest of the poor. In fact, many economically backward families would rather go into debt over private hospital's medical bills than entrust a loved one to a government healthcare facility. Meanwhile, 60 per cent of all patients admitted develop infections while in hospital, from the sheer unsanitariness of the facilities.

We suggest

Funds from the Centre be linked to accreditation, pushing more states to aspire to internationally recognised standards of healthcare, as defined by Quality Council of India.

To start with, hospitals should start outsourcing support services like data management, accounts and kitchen services to enhance accountability and leave them free to focus on providing quality healthcare.

Gradually, they could move up the scales, improving patient management, work culture and infrastructure to finally certify for accreditation by the Quality Council of India's NABH (National Accreditation Board for Hospital and Healthcare Providers) or the International Organization for Standardisation (ISO).

Related linkss:

Statistics: Hospitals in India

Health scenario around the world