ECHS needs improvement

Brig  Amarjit Singh Randwal (Retd)
J&K Sai Star Society, a rural development NGO in association with S P Jain Institute of Management & Research, a top Management Institute of India has carried out a study to find Gaps in implementation of Ex-Servicemen Contributory Health Scheme (ECHS) and suggest avenues for improving the same.
The Study report identifies the gaps in the implementation of the ECHS, which was inaugurated in 2003 to provide comprehensive and quality medical care to veterans of the armed forces and their dependants. The report suggests possible solutions to overcome these issues faced while executing the scheme. The report also explores the possibility of reorganizing the scheme as a corporate entity to eliminate multiple stakeholders and facilitate faster decision making.
It was found that there is a lot of dissatisfaction with the present state of the Ex-servicemen Contributory Health scheme. The primary causes behind this can be broadly divided into two categories.
Ground Level Problems, which are due to lack of effective implementation of policies, which include problems such as lack of awareness about the scheme, staffing problems, high lead time in the procurement of medicines, delays in bill processing and absence of effective vigilance and grievance management systems.
Then come  macro level problems which include inadequate authorization of manpower and long winded procedure for empanelment of Hospitals. Moreover, the scheme faces the problem of dual control;  policy matters are under the jurisdiction of the Ministry of Defence, Central Organization ECHS and Regional Centers. However, the scheme is dependent on the existing chain of command of the armed forces for administrative matters.
Due to these issues, the ex-servicemen are unhappy with the service that they are receiving under the scheme. The employees working at polyclinics are also dissatisfied with the state of affairs which negatively impacts the quality of service they render. The inordinate bureaucratic delays are a further impediment to the effective functioning of the scheme as they prevent timely changes to policies.
The recommendations in the report are of two types – recommendations that are directed towards specific problems identified and general recommendations to improve the overall efficiency of the scheme. The underlying principle behind all the measures is to reduce the dependence of the scheme on the army chain of command. More powers needs to be given to the regional centers in matters related to clearance of bills, procurement of medicines, vigilance etc. to overcome ground level problems. The  ECHS should be reorganized as a corporate entity with a board of directors to aid in the more professional management of the scheme.
The current management structure is wrought with bureaucratic delays and multitude of stakeholders. The Department of Ex-Servicemen Welfare (ESW) under the Ministry of Defence exercises Executive Control over the scheme. The Administrative Control is with the Adjutant General (AG’s) Branch. The office of the Director General Armed Forces Medical Services (DGAFMS) is responsible for Procuring Medicines for the scheme. The Functional Support is provided by the command chain of three armed forces. This has caused a decision paralysis. Important decisions take months, sometimes years, to materialize that adversely impacts the operational efficiency of the scheme.
On the other hand, the management bodies of ECHS, the Central Organization and the Regional Centers have not been given adequate powers for managing and implementing the scheme. For example, the Central Organization lacks the power to make any policy changes without the approval of the Ministry of Defence.  Minor administrative issues also need sanction from Ministry of Defence, i.e., reimbursement for Air travel  in emergency cases for life saving treatment to a Military/Empanelled Medical facility is required to be sent to the Ministry of Defence for  its consideration and sanction.  All these factors have led to inefficient implementation of the scheme which has led to a lot of dissatisfaction among the various stakeholders – the ex-servicemen, the employees at polyclinics, the civil/empanelled hospitals and administrators at Central Organization.
The ECHS currently has over 40 lakh beneficiaries. This number is going to steadily increase in the future and is expected to stabilize at 65 lakhs by 2020. The present day dynamics of an increasingly demanding clientele coupled with rapidly changing technology has made a paradigm shift in healthcare management. All these factors are bound to make the management and implementation of the scheme more complex.  Thus, there is an urgent need to carry out a reorganization of the executive control of the scheme.
(Brig Amarjit Singh Randwal is former Dy. Commandant of Officers Training Academy & was also Director of AGI Medical Benefit Scheme at Army Headquarters)

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