Hospitals For Defence Veterans

According to news reports, hospitals for defence veterans are to be developed in eight cities across the country: Ambala, Bareilly, Bengaluru, Chennai, Dehradun, Delhi, Hyderabad and Jalandhar, with private partnership using CSR funds. It is being said that these eight locations have been preferred as a large number of ex servicemen (ESM) reside there, and a certain ecosystem already exists where private entities can partner with the government to set up veterans’ hospitals.

Examples of Reliance, ONGC, GAIL, Infosys and Tatas spending CSR funds for creating large medical infrastructure have also been quoted.

According to the MD ECHS (Ex-Servicemen Contributory Health Scheme), “The plan is to have 200 to 400-bed hospitals. Infrastructure can be developed by private entities on defence land or land along with developed infrastructure would be given for the private entity to manage the hospital. Through these models, the cost of medical treatment could be reduced. The hospital will be open for civilians too. It will differentiate between corporate competition and welfare.”

At face value, the above amounts to creating additional medical facilities at these eight locations that would “also” cater for defence veterans. However, closer scrutiny raises multiple questions. These are discussed in succeeding paragraphs.

First, is the private partnership planned with ‘local’ business entities and has any dialogue been done with them? If so, banking on only local businesses for private partnerships is absurd when scores of Indian private companies are global, more are going multinational and 25 Indians leading companies with total market cap of $5 trillion is currently greater than the Indian GDP, who would certainly have more CSR funds and perhaps would be more amenable to invest in hospitals for defence veterans.

Second, while the above eight locations have been selected because of the large number of ESM, how about similar large concentrations of ESM elsewhere, for example, Kangra District in Himachal Pradesh and Bhiwani District in Haryana? To say that these will be considered subsequently would not be enough. A pan-India plan should have been made and then prioritised, if found feasible.

Third, what is meant by land or land along with developed infrastructure would be given for the private entity to manage the hospital? Which is this ‘developed infrastructure’? This certainly does not bode well and could lead to underhand deals.

Fourth, if the hospitals planned are also open to civilians or rather the public including those covered under the CGHS (Central Government Health Scheme), why are they being labelled “Veterans’ Hospitals” and how are they different from existing private hospitals which are affiliated to ECHS? Why this duplication?

Fifth, if the hospitals are to be managed by civilians, would veteran doctors and staff get preference for employment in these hospitals? Conversely would veteran doctors, specialists, super-specialists prefer employment in these hospitals compared to other private hospitals?

Sixth, the ECHS polyclinics continue to face shortage of medicines. Government has no doubt increased the overall fund allocation to the ECHS but 60,000 personnel retire annually from the Army alone. In such a backdrop what ECHS funds are planned to be used in establishing these new hospitals and the treatment (also treating civilians)? Is it wise to sink ECHS funds in new hospitals when private hospitals are affiliated to ECHS?

Seventh, the availability of CSR funds and their quantum can only have some level of certainty if MoUs are signed with the concerned private businesses because priorities of CSR funding by the corporate keep changing. Is this planned? CSR funding must also bear in mind the increasing costs of medicines with each passing year. In this context, the claim that the cost of treatment would be reduced in these hospitals also needs closer examination.

Eighth, are we creating white elephants where the profit goes to the corporate with no cost on land and available infrastructure? What is the accountability if the management and quality of treatment at these hospitals is not up to the mark?

Ninth, with civilian patients outnumbering the veterans, will old veterans and widows be subjected to stand longer in extended lines?

Tenth, inimical elements would have easy access to defence establishments under the pretext of visiting these hospitals for treatment.

One wonders if any military doctors, specialists and super-specialists (serving and veteran) were consulted before announcing this scheme, leave aside any veterans. A better method would have been to “augment” the existing medical infrastructure of the military as also ECHS Polyclinics by using CSR funds of the corporate. However, to do this, a very detailed plan of expansion would need to be prepared and the quantum of CSR funds required established, followed by liaison with the corporate.

Ironically, the norm has become to push through a scheme once announced, no matter the shoddy homework, shortcomings and adverse fallout because of hasty implementation; the most recent example being SPARSH. Hopefully, this scheme of Veterans’ Hospitals would get reviewed utilising whatever possible slim chance.

The policy makers and the MD ECHS need to look into the following:

•  Regular feedback and monitoring of availability and disbursal of medicines in ECHS Polyclinics and timely corrective measures to avoid shortages.
• Examine why certain private hospitals have discontinued ECHS affiliation – is it because expenditure was not reimbursed in an acceptable time frame? Veterans were obviously using these hospitals being proximate to them. Can their ECHS affiliation be revived?
• ECHS affiliated private hospitals have the facility of booking appointments with doctors/specialists indicating date and preferred time. But for veterans to book appointments, the consultation fee required to be paid in advance is the “full fee”, which is many times more than the consultation fee under the ECHS scheme. Can this be streamlined? It would avoid standing in long lines to obtain an appointment.
• With online connectivity, delegation of more authority to the OIC ECHS Polyclinic needs to be examined. For certain sanctions/counter signatures, old veterans and widows (some without own transport) are required to go to Base Hospital, Delhi Cantonment where the competent authority accords the sanction only between specific hours. This can be obviated with polyclinics obtaining the sanction online and handing over the same to the veteran/widow.

Lt General Prakash Katoch is a veteran of the Indian Army. Views expressed are personal