Govt makes mess of free dialysis scheme

Govt makes mess of free dialysis scheme
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‘Releases Rs 1.5 crore under NDP without trained technicians or PPP bidder’

SRINAGAR: In violation of the operational guidelines of the National Dialysis Programme (NDP), the J&K Health department has released nearly Rs 1.5 crore to government hospitals despite this being done without the approval of the government of India (GoI), Kashmir Reader has learned.
According to official sources, 14 government hospitals, seven each in the Kashmir and Jammu divisions, have already started construction of ‘free dialysis centres’ in an utterly unregulated manner because there are no trained technicians available, mandated for running this sensitive facility at various district hospitals. An experienced private partner is also not involved in the programme because of a poor response to the tendering process.
As per the NDP’s operational guidelines, the dialysis services should be run by District Hospitals under the Public Private Partnership (PPP) mode with trained manpower to run the facility without any hassle or risk of infections.
“The direct provisioning by the governments would be time-consuming and likely to be costly and risky,” the guideline reads.
It says the service provider shall provide a medical human resource, a dialysis machine along with RO water plant infrastructure, dialyzer and consumables.
“Payer Government should provide space in District Hospitals, drugs, power and water supply and pay for the cost of dialysis for the poor patients,” it adds.
However, J&K’s National Health Mission (NHM) authorities went ahead with the project, even though no private party was involved to run it smoothly.
The tenders for running these dialysis centres were floated in June 2017. However, due to the poor response from private companies, the scheme couldn’t be started.
“No bidder or company came forward to participate in the repeated tenders floated by NHM as the notices were flawed,” said an official privy to the process.
He said the NHM is not the procurement or tendering authority to float the tender because the J&K Medical Supplies Corporation Limited (JKMSCL) is the dedicated agency meant for the purpose.
“The other reason is poor knowledge of the subject matter and incompetence. The non-availability of trained technicians and nephrologists are the other pertinent reasons behind the poor response,” the official said.
Sources told Kashmir Reader that the recent announcement by Minister for Health and Medical Education Bali Bhagat that “dialysis centres will be started in all government hospitals soon” is a hoax to receive more funds under the scheme before the current fiscal ends on March 31.
“I think the minister is not fully aware of the scheme or he is just pleasing the government of India to get more funds before March 31. Otherwise, the dialysis facility must have a dedicated and trained staff to run it smoothly to prevent any mishap and infection,” they said.
As per an NHM official, the announcement is merely eyewash as there is no proper approval from the Ministry of Health and Family Welfare, GoI, to run these facilities without the PPP mode.
“The NHM director has restricted the competition by incorporating illogical, irrational and irrelevant clauses, terms and conditions which lead to zero participation from private investors,” he said.
“Instead of making amendments or modifications to ensure healthy competition and a judicious tendering system, he has complicated the process. This means a serious treatment programme scheme has been started in a hotchpotch manner to mislead the government of India and please the current régime,” the official said.
A nephrologist told Kashmir Reader that public interest and patient care are necessities but not at risk or cost to life caused by carrying out experiments via temporary arrangements or playing with the lives of below-poverty-line patients just to ensure the disbursement of service obligations by any such incumbency.
“Dialysis is a matter related to deaths due to cross infections and allied complications. Solemn precautions must be taken, and any speed or rush may result in untimely and unfortunate losses or damages to precious lives. Be they BPL or APL, all matter,” he said.
As per rough estimates, there is an average increase of about 10,000 renal failure patients in J&K. And, as per the NDP report, patients largely depend upon the private sector, where a single dialysis costs an additional Rs 2,000.
“Yearly, expenditure for patients is Rs 3 to 4 lakh, excluding the heavy travel and staying costs and loss of wages for the patient and family members accompanying the patient,” the report said.
“The… (NDP) was launched to reduce out of pocket expenditure for patients and their families through PPP mode,” it said.
Mission Director NHM, J&K, Dr Mohan Singh admitted that no private partnership could be initiated because of poor response from companies. However, he said, the Chief Medical Officers concerned had assured that trained manpower would be provided to run the free dialysis scheme.
“We are trying our best to start the facilities as soon as possible. Our target is to start 14 dialysis centres in Jammu and Kashmir within three months,” Dr Singh said.
Asked whether there is GoI approval to run these centres, he said: “The department is working to get approval for all the 14 centres. Till now, we have approval for two centres, one at District Hospital Anantnag and another at District Hospital Gandhi Nagar, Jammu.”