Tamilnadu Visit Report
By
Dr. P.C.Ranka & Ashutosh Bajpeyee
The visit to Tamilnadu state
The Tamilnadu state Health systems Development Project (TNHSDP) office was visited on April 16, 2009. Detailed discussions were held with the Project Director and other project officials, this interaction also included exchange of views regarding various activities undergoing in both the projects. There was also a discussion on the issues forthcoming in both the project including the proposals for utilization of savings etc.
The project Director was kind enough to arrange for all visits for next two three days and took special interest to facilitate with all requisites.
The visit subsequently started with the project office itself.
1. Equipments Management System
Meeting with Bio-Medical Engineers and Visit to Health Facility
1.1 A monthly review meeting of all the Bio-medical engineers was attended which was scheduled for the same day incidentally. A detailed interaction with all field functionaries was held. In addition to this detailed discussion was also held with one of the BME at the Government Hospital Sri Perumbudur. Following issues were understood;
1. In Tamilnadu there are 15 BMEs have been recruited and they are serving at TNMSC. The recruitment was done by TNHSDP.
2. Each BME covers almost three districts as far as the equipment management in the health facilities is concerned.
3. These BMEs are required to travel and attend each health facility and inspect all the equipments installed therein.
4. In case of any problem and non-functionality reported for any equipment the BME feeds the required information in to the computerized health management system which in turn reaches to the TNMSC.
5. The BMEs do have kind of a tool-kit with them and are supposed to attend all minor problems at the site itself.
1.2 This system is existence is functioning well in the state and BMEs have contributed positively for equipments management. The project is also considering recruitment of additional 10 BMEs in near future.
The management system is administered by the TNMSC at the apex level and sufficient logistics and other arrangements are well organized. TNMSC controls all equipment supply and management system including repair and AMCs for each equipments. These AMC contracts are managed centrally at the TNMSC headquarters only. No health facility in the state has independent AMCs and other repair systems of their own.
1.3 Despite all the positive impacts of the BME based equipments repair and management systems of Tamilnadu there are few potential bottlenecks that were observed.
1. Although each BME has a tool-kit with them but hardly any of them carries the same while visiting a health facility. Reason for this is mainly the inconvenience in carrying the tool kit. The traveling arrangements are not smooth for BMEs. They have to travel on their own.
2. Once a snag is detected in any equipment at any health facility the BME has to report the problem to the health facility in charge in addition to reporting it to the TNMSC through computer. This is not much effective process though seems to be working in principal only.
3. The health facility in charge has limited financial powers and it takes quite long in arranging or purchasing any minor spare parts and till it is arranged the equipment lies unattended and un-repaired.
4. The BME has no such facility to arrange the required spare part on its own. The tool-kit does not contain any such part.
5. BMEs were effective in timely reporting the outages in all major equipments but this was also mainly because of the timely action by the health facility in charge also.
6. One BME has to cover three districts at one time and therefore the timely attending each health facility is quite infrequent. As a result the timely reporting of outages of minor equipments is severely hampered.
1.4 As a whole the system of equipments management is functioning with moderate success in the state of Tamilnadu. There are several minor issues must be addressed well in case the same system is replicated and implemented elsewhere. Attending the outages of major equipments can always be covered up through the well managed Annual Maintenance Contracts at central level but addressing the multiple minor issues becomes extremely critical.
2. District Hospital Functions
Visit to the District Hospital –Kanchipuram
The visit to the district hospital at Kanchipuram was very exhaustive. Almost all the major activities and functions being carried out at the district hospital were understood. Detailed discussions and interactions were also held with in charge of the hospital, other doctors and staff . Following issues were understood and analyzed in detail;
CME : Tele-medicine
The hospital had a dedicated tele-medicine center. This was a well equipped center and was a good center facilitating CME. While visiting a class was already undergoing and para-medical staff was attending the session.
The in-charge of the hospital explained that the tele-medicine is helping functionaries to a great extent. However, doctors find less time for attending these sessions.
2.2.1 Public Drug Distribution System
The district hospitals (DH) in Tamilnadu have 24 X 7 drug distribution system in place and it is very effective. The drug logistics system is totally computerized and all the drugs are distributed at the hospital itself. There are no drugs and medicines prescribed to any patient(s) that can be purchased from outside the hospitals. Similarly, all the testing are also conducted at the hospital itself and these are completely free or with minimum charges.
There is a specific drug distribution center at the each hospital across the state. The stores in the hospitals are connected with the computerized logistics system in some of the district hospitals where a pilot is underway. These district hospital stores enter their consumptions and requirements on daily basis in to the designated software (hospital management system).This in turn collected with all data and informations at the central server at DMS. The demand and supply arrangements are accomplished by the by DMS at present.
There are normally two window drug delivery and distribution system at each hospital. There is spate window for men and women exclusively. In addition to this the drugs and medicines are also delivered and distributed to the wards and ICU etc depending upon the demand generated each day.
There is no connectivity with the district drug warehouse and the hospitals within the district. Presently the drugs and medicines demand and supply mechanism is based on manual systems and drugs supply is ensured by the drug ware house in the district on the bsaisi of demand generated and reported.
The health facilities including the district hospitals will have to collect their drug supplies from the drug ware house of the district in particular. For small health institutions this is a problematic logistics where they have to approach the drug ware houses and collect their supplies. Although, there is a system of reimbursement of payment of transportation charges, It is based on the assumptive diesel consumption charges per kilometer of 9km/lit.
Doctors have no problem with it but the supply goes slow if the connectivity is slow. And it is so after 9.30 AM when the OPD is its peek especially on Mondays, Wednesdays and Fridays when specialty medicines are dispensed.
Essential drug list is revised every year. The committee is as follows
MD. TNMSC ,Director PH, Dir. Rural Health, Dir. FW ,Dir. Med. Edu., Dir Drug Controller, Prof. of Medicine and Surgery.
Total Budget of the of the corporation is 200 Crores per year.
Stock position and need assessment is done on the basis of 1% rise of last year Per Monthly calculation of need multiplied by months minus stock remained in that month.
Drug Testing System with Drug Testing Laboratories
Tamilnadu has 10 designated drug testing laboratories (DTL) in all. Drug samples are derived from across the state as and when required and sent to these drug testing laboratories.
On an average it takes around 7-21 days in testing the submitted drug samples and reporting the quality check back to the consignee.
In case of a sample fails in its testing to the standard norms and pharmacopeia standards , a second check is conducted and the supplier is asked to take away the goods else pay 2% penalty ( material stocking charges) on spurious supplies.
It was reported that the average drug sample failure rate is 0.23% in the state.
They have recommended that state may initially use the state ware house corporation or FCI / district hospital stores.
District drug ware house corporation Man Power is as follows
Pharmacist 2
Data entry Operator 1
Pickers 2
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