Free diagnostic services at Public Health Care Delivery Institutions

Free diagnostic services at Public Health Care Delivery Institutions  Dr. P.C.Ranka, Rajasthan, Jaipur, India

Reference material for all those working on Implementation of Nishulk Janch Yojana    (Free    Diagnostic     Services) at Public Sector Health care delivery institutions

              As per announcement made by Hon’ble Chief Minister common essential diagnostic tests are to be provided free of cost at Medical College Hospitals and District Hospitals in the state with effect from 7^th April, 2013. After implementation of Mukhyamantri Nishulk Dava Yojana, provision of this facility will be another milestone in the state’s health sector. Rajasthan Medical Services Corporation has been identified as the nodal agency for facilitation of the scheme. In phase I the scheme envisages provision of 57 free basic diagnostic tests at Medical College Hospitals and 44 at District Hospitals, Sub-divisional Hospitals and Satellite Hospitals. In the next phases the scheme is to be extended to Community Health Centres and Primary Health Centres.

The phased implementation will be as follows:

Phase	Implementation Date	Level of Implementation	No. of Tests
Phase I	7th April,2013 (World Health Day)	Medical College Hospitals(MCH) District Hospitals(DH),Sub-divisional Hospitals(SDH) and Satellite Hospitals(SH)	57 44
Phase II	1st July, 2013 (Doctor’s Day)	Community Health Centres (CHCs)	28
Phase III	15th August, 2013 (Independence Day)	Primary Health Centres (PHCs) & Dispensaries	15

            All Medical College Hospitals, District Hospitals/Sub-divisional hospitals and Satellite hospitals have been directed to start preparedness for implementation of the first phase of scheme. For ensuring success of the intervention, the following are to be carried out as indicated below: -

SHORT TERM ACTIVITIES FOR STRENGTHENING OF LABORATORIES at MCH, DH, SDH &SH

S. No	Components	Immediate Action (Jan 13 -March 13)
(I) Gap Analysis and Filling of Gaps
1	Infrastructure	Repair, renovation, establishment of collection counter & report distribution  centres
2	Manpower	Deployment of Lab Technician/Lab Assistant/Radiographer from existing staff * Deputation of LT/LA/Radiographer through RMRS if required
3	Equipments	Repair of existing equipments Arrange new diagnostic equipments
4	Reagents and Consumables	Local purchase at hospital level **
(II) Training
1	Training of Doctors	Orientation & Hands on Training of Doctors (10 days)
2	Training of LT /LA/RG	Orientation & Hands on Training of LT /LA/RG (10 days)
(III) IEC
	Display Boards	Display board of list of available tests (blue base with white letters)  outside  the laboratories  ( instructions will be issued separately and bills of RMRS reimbursed)

· As the 1st phase has to start from 7^th April, 2013 at MCH and DH/SDH/SH immediate steps are to be initiated locally by the concerned Medical Superintendent and Principal Medical Officer to fill these gaps of infrastructure, manpower, equipments and reagents and consumables using Rajasthan Medicare Relief Society (RMRS) funds. Moreover as indicated above the unused untied fund, Annual Maintenance Grant, Corpus fund etc. available with RMRS may also be used for this purpose.

· This expenditure and every recurrent expenditure on outsourced services (Public Private Partnership) operating as per outsourcing policy of G o R will be reimbursed by the state government, these accounts be maintained separately.

· To compensate for other expenditures which were earlier met by income from lab tests, demand for more budget under Office Expenditure head has to be sent to Directorate of Medical &Health Services and Principal Secretary (ME) as directed during video conferencing so that its provision can be made under the Office Expenditure budget head by the respective departments. You are required to send budget estimate under this head @ 50% of last year’s RMRS income for Budget Finance Committee. (Initially for next 3 months followed by that for next financial year 2013-14).

· Hands on training of manpower will be undertaken at medical colleges by the Pathology department for the districts in their  respective division .(module will be shortly shared with all medical colleges)

As activities like constitution of new labs, recruitment of new staff, tendering and supply of new equipments and lab reagents may take few months the following actions are to be carried out over next 4 to 6 months.

                   

                 LONG TERM ACTIVITIES FOR STRENGTHENING OF ALL LABORATORIES

                                        at MCH,  DH, SDH, SH, CHCs, PHCs and Dispensaries

S. No	Component	Immediate Action (Next 4-6 months)
1	Infrastructure	Creation of additional space in existing laboratories
2	Manpower	Deployment of Pathologist  (MO-PG/JS/SS)
		Deployment of Radiologist (MO-PG/JS/SS)
		Recruitment of regular LT, LA ,IA,RG etc.
3	Equipments	Supply of  new lab equipments by RMSC as per demand
4	Reagents	Supply of essential lab reagents and consumables by RMSC as per demand

For ensuring the availability of functional equipments and lab reagents following units will be established    and related activities will be carried out under RMSC:

1.       Establishment of EPMC: which will prepare essential equipment list (EEL) and essential laboratory reagents and consumables list (ELRCL) as advised by TAC and will procure and supply them through DDWs to all hospitals which demand them.

2.       Establishment of SEMRC, ZEMRC and DEMRC: State equipment maintenance and repair centres (SEMRC) along with the zonal equipment maintenance and repair centres (ZEMRC) at divisional level and district equipment maintenance and repair cell (DEMRC) will be established to ensure preventive maintenance and repair of equipments.

3.       Procure and supply essential laboratory reagents, chemicals and consumables: at DDWs and store these until they are issued to hospitals (along with drugs) for proper functioning of diagnostic facilities.

4.       Quality control – quality policy has been developed and its compliance will be ensured by establishment of Quality Assurance Program Implementation Unit at state level at RMSC, at zonal level at medical colleges and at district hospitals in the districts.

5.       Bio-safety – Standard Operating Procedures (SOPs) for healthcare workers will be developed and issued and personal protective gear for bio-safety will be provided to all laboratory staff.

6.       BMW Rules implementation – all healthcare institutions are legally bound to implement Bio Medical Waste (Management & Handling) Rules  (1998 amendment 2000 & 2003) and it will be the responsibility of medical office in-charge to ensure disposal of laboratory generated bio-waste as per rules and obtain Common Treatment Facility(CTF) connectivity for same.

7.       Provision for back-up equipments - all medical officer in-charges to ensure stand by invertors and generators for emergency times as also additional standby equipments.

8.       Patient friendly services – ensure proper waiting space, shed, counter for registration, sample and report collection such that the patients do not have to wait for more than 10 minutes at these counters. Medical college hospitals to ensure availability of online report of diagnostic tests.

9.       Display of Boards - of list of available tests outside the laboratories (on blue background with white letters) and also board indicating time of sample and report collection.

10.    Ensure 24x7 lab services -for Intensive Care Units (ICU), in patients department (IPD) emergency/casualty and other serious patients at MCH, DH, SDH and SH.